Documente Academic
Documente Profesional
Documente Cultură
THROMBOSIS
Abdul Rahim Bin Mohamad Nor
C 111 10 871
SUPERVISOR
Prof.dr.Peter Kabo,PhD,SpFK,SpJP(K),FIHA,FASCC
PATIENTS IDENTITY
Name
: Mrs. S
Age
: 58 y.o.
MR
: 049115
Admitted : November 24th , 2015
HISTORY TAKING
Chief complaint
Swelling on the right leg
HISTORY TAKING
exist.
RISK FACTOR
Aging
Malignancy
PHYSICAL EXAMINATION
General state :
Moderate illness/well nourished/ conscious
Vital status
Blood Pressure : 130/80 mmHg
Pulse Rate : 90 bpm (regular)
Respiratory Rate
: 20 tpm
Temperature : 36,5 0C (axilla)
BW
: 50kg
BH
: 151cm
IMT : 21.91
PHYSICAL EXAMINATION
PHYSICAL EXAMINATION
Cor :
Inspection
Palpation
Percussion :
dull, Upper border 2nd ICS linea parasternalis sinistra,
Right border 4th ICS linea parasternalis dextra, Left
border 5th ICS linea medioclavicularis sinistra
Auscultation: heart sound I/II pure, regular, murmur (-)
PHYSICAL EXAMINATION
Abdomen :
Inspection
Percussion : tympani
Extremities
LABORATORIUM (November, 1
st ,
2015
HEMATOLOGY
RESULT
NORMAL VALUE
WBC
4.0-10.0 x 103
RBC
3,96 x 106/mm3
4.0-6.0x106
HGB
10,5 g/dL
12-16
MCH
21,5 pg
26,5-33,5
MCHC
31,7 gr/dL
31,5-35
HCT
31,4
37-48
PLT
486 x 103/mm3
150-400 x 103
Ureum
54
10-50 md/dL
Creatinin
1,2
<1.3
Na
137
136-145 mmol/l
4,1
3.5-5.1 mmol/l
Cl
110
97-111 mmol/l
PT
17,4
10-14 detik
INR
1,45
APTT
36,5
22.0-30.0 detik
D Dimer
3,98
< 0,5
ELECTROCARDIOGRAPHY
(November 1st 2015)
Echovascular
Blood flow from
distal to proximal is
not flowing well with
thrombus in
Common Femoral
Vein and Right
Popliteal vein.
CONCLUSION:
Deep Vein
Thrombosis
Resume
Women 58 yo came with Edema on right leg occurs since one
week ago, the right leg slowly beginning to swell, pain(+) and
cramps(+). History of hypertension(+) on treatment,
Malignancy(+): Carcinoma Cervix. Physical examination on lower
extremities: Edema on the right leg, warmt(+). Homans sign(+).
Risk factor: Carcinoma Cervix, Wells Score: +2
Laboratory finding: WBC: 19,29, PLT: 429000 , PT: 17,4, APTT:
DIAGNOSIS
Deep Vein Thrombosis
TREATMENT
IVFD NaCl 0.9% 500cc/24h/intravena
Alpentin 100 mg/24h/oral
Simarc 2 mg/24h/oral
MST 15 mg/24h/oral
DISCUSSION
DEFINITION
PATHOGENESIS
CLINICAL FEATURES
specific symptom.
Leg pain occurs in 50% of patients, but
this is entirely nonspecific. Pain can
occur on dorsoflexion of the foot
(Homans sign).
Pratt's sign: Squeezing of posterior calf
elicits pain.
DIAGNOSIS
Well score
D-Dimer
D-Dimer, a byproduct of brin degradation that can be
ALGORITHMA OF
DIAGNOSIS
TREATMENT
INITIAL TREATMENT OF
DVT
In clinically suspected DVT, treatment with UFH or
MANAGEMENT OF IV
UFH
Initial dose
80 IU/kg bolus, then 18
IU/kg/hr
APTT < 35 s (<1.2x control)
No change
APTT 71 to 90 s (2.3 to 3x
control)
SUBCUTANEOUS UFH
LMWH recommended
LMWH recommended Treatment
Enoxaparin (Clexane)
1 mg/kg twice
daily
Nadroparin
(Fraxiparine)
MAINTENANCE TREATMENT
OF DVT
DURATION OF
THERAPY
Time
3 to 6 months
Event
first event with reversible or
time-limited risk factor
(Surgery, trauma,
immobility, oestrogen use)
= 6 months
12 months to
lifetime
- first event with
cancer
until resolved
anticardiolipin antibody
- antithrombin deficiency
- recurrent event, idiopathic
or with thrombophilia
THANK YOU