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Recurrent thrombosis despite anticoagulation in a man with monocytosis. Case 8
J Bösiger1, F Demarmels Biasiutti
1Central Haematology Laboratory, Inselspital, University Hospital, 3010 Bern, Switzerland.
Hamostaseologie
|August 19, 2003
Summary
Recurrent blood clots despite standard anticoagulation may signal cancer. This case highlights severe thrombophilia due to antiphospholipid syndrome, protein S deficiency, and chronic myelomonocytic leukemia, requiring intensified anticoagulation.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Recurrent thromboembolism despite anticoagulation often raises suspicion for underlying malignancy.
- Standard anticoagulation regimens may be insufficient in complex thrombophilic states.
Observation:
- A 67-year-old male presented with severe thrombophilia resistant to conventional oral anticoagulation.
- The patient required combined anticoagulation with high-dose low molecular weight heparin and phenprocoumon (target INR 2.0) for control.
- Despite extensive investigation over two years, no overt or occult neoplasia was identified.
Findings:
- The patient had coexisting antiphospholipid syndrome, protein S deficiency, and chronic myelomonocytic leukemia.
- This combination of conditions likely contributed to the severe, treatment-resistant thrombophilia.
- Abnormal monocytes in chronic myelomonocytic leukemia may have procoagulatory effects.
Implications:
- This case underscores the need for comprehensive etiological investigation in patients with refractory thromboembolism.
- Combined and intensified anticoagulation strategies may be necessary for managing severe thrombophilia in specific clinical scenarios.
- Understanding the interplay between hematologic disorders, autoimmune conditions, and thrombogenicity is crucial for optimizing patient care.