Case 9 A 30-year-old woman has experienced a third thrombotic episode after star

Question

Case 9

A 30-year-old woman has experienced a third thrombotic episode after starting to take oral contraceptives. She has family members with a similar history.

PT: 12.0 sec

aPTT: 26.8 sec

PLT: 285  109/L

1. Interpret the coagulation screening tests.

2. What additional tests should be performed?

Evaluate the results of the following additional studies:

aPTT-based activated protein C (APC) resistance test: ratio of 1:6 (normal ratio 1:8)

Factor V Leiden mutation molecular assay: positive (heterozygous)

3. Based on all the data provided, what condition is most likely?

4. What information is most diagnostic?

Explanation / Answer

1. Interpretation and reporting of coagulation screening test is a time consuming task by using web based reporting system. It is tested after couple of months of thrombotic episode or when not responding as expected to heparin anticoagulation therapy.

Screening test includes prothrombin time, activated partial thromboplastin time, thrombin clotting time , fibrinogen concentration and platelet count .

2. Additionally tests like thrombin time testing, lupus anticoagulant testing, anticardiolipin testing and B2GP1 antibody testing .

3. The condition is most likely to be hereditary thrombophilia and thrombosis , where increased levels of prothrombin or factor VIII is observed due to presence of lupus anticoagulant or oral contraceptive use or pregnancy.

4. Results of factor V DNA analysis were compared with three different clotting based assays which are designed to detect activated protein C(APC). The gene that codes the protein is referred to as F5.

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