CASE 17

PATIENT: 75-year-old white woman

CHIEF COMPLAINT: Elective resection of Abdominal Aortic Aneurysm (AAA).

MEDICAL HISTORY: This patient was admitted for elective surgery after an incidental finding of a large AAA by ultrasound imaging. Patient was asymptomatic at the time of admission.

FAMILY HISTORY: Not remarkable.

DRUG HISTORY: Nor remarkable.

PHYSICAL EXAMINATION: The patient was moderately obese. Her physical examination was otherwise not remarkable.

LABORATORY RESULTS (on admission):

	Patient	Normal
Prothrombin time	10.9 seconds	8-11.5 seconds
aPTT	33 seconds	24-37.5 seconds
Platelet count	480,000 /μl	150,000-350,00/μl

HOSPITAL COURSE:

The patient underwent surgery on the second day of hospitalization. Postoperative course was complicated by vascular insufficiency in the lower extremities presumable due to hypercoagulation. The patient was started on Heparin therapy on post-op day 1. Her platelet count progressively decreased down to 29,000 /μl on post-op day 2. Vascular insufficiency in the lower extremities deteriorated further and a comprehensive work-up for underlying hypercoagulation was initiated.

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