Case history
Case history #1
A 30-year-old woman presents for assessment of thrombophilia, as her sister was recently diagnosed with a deep venous thrombosis associated with pregnancy. She is a smoker and recently started a combined oral contraceptive pill.
Case history #2
A 54-year-old man presents with pain and swelling of his left leg. He has a 30 pack-year smoking history. On examination, his left leg is grossly swollen to the thigh. D-dimer (marker of fibrinolysis) is elevated. Chest x-ray suggests a right hilar mass.
Other presentations
Hypercoagulable state may present as venous thrombosis at unusual sites such as the upper limb, cerebral sinus thrombosis, or intra-abdominal (mesenteric, hepatic, and renal) vein thrombosis. Other rare presentations include purpura fulminans and warfarin-induced skin necrosis.
Arterial thrombosis, such as stroke or myocardial infarction, can be a feature of some hypercoagulable states such as antiphospholipid syndrome, heparin-induced thrombocytopenia, and malignancy.
Other hypercoagulable states may be associated with adverse pregnancy outcome, including miscarriage, stillbirth, severe pre-eclampsia, intrauterine growth retardation, and placental abruption, although there is insufficient evidence to confirm causality.[4]
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