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 birth control 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 preeclampsia, intrauterine growth retardation, and placental abruption, although there is insufficient evidence to confirm causality.[4]
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