PATIENT: 45 year-old woman
This patient was admitted
with massive hemoptysis. At the time of
admission, she was receiving Coumadin (sodium warfarin) for superficial
thrombophlebitis. The patient’s prothrombin
time was 21 seconds, although she had not taken Coumadin since the day
preceding admission
MEDICAL HISTORY: The patient
had an episode of deep vein thrombosis after the birth of her second daughter
when she was 30 years old. The patient
was placed on heparin, which was then followed by oral anticoagulants for 6
months.
After a spontaneous abortion
at the age of 32, the patient was placed on oral contraceptives. She subsequently experienced superficial left
calf vein thrombophlebitis, and the oral contraceptives were discontinued. Two months prior to this admission, patient
developed superficial thrombophlebitis of the legs that were not associated
with trauma. Patient was started on
Coumadin at that time.
FAMILY HISTORY: The paternal
grandfather, who died at 32 years of age, had a history of “swollen legs”. The patient’s father had a pulmonary embolism
at 27 years of age after appendectomy, and he died suddenly at 42 years of age
after an attack of thrombophlebitis of the left leg. Also, a cousin died at 39 years of age after
several episodes of thrombophlebitis.
Another cousin, 63 years of age, had a number of problems with
thrombotic disease, including a history of arterial embolism that necessitated
amputation of the left leg at the knee.
DRUG HISTORY: At the time of
the initial evaluation, the patient was on no medication.
PHYSICAL EXAMINATION: Superficial
varices were noted over the legs.
PT= 21 sec (Normal 8-11.5)
aPTT = 43 sec (Normal
24-37.5)
Plt= 315,000 /μL (Normal
150,000-350,000)