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Procoagulant Platelet Characterization by Measuring Phosphatidylserine Exposure and Microvesicle Release from Human Purified Platelets

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Case 294: Catastrophic Antiphospholipid Syndrome.

Marianne Golse¹, Maxime Barat¹, Nathalie Costedoat-Chalumeau¹

¹From the Departments of Radiology (M.G., M.B., M.P.R.) and Internal Medicine (N.C.C.), Cochin Hospital, APHP.Centre, 27 Rue du Fg St Jacques, Paris 75014, France; and Université de Paris, Paris, France (M.B., N.C.C., M.P.R.).

|September 20, 2021

Summary

A 50-year-old woman developed lower limb pain, later experiencing dyspnea and chest pain after anticoagulation for bilateral calf vein thrombosis. This case highlights potential complications of deep vein thrombosis and its treatment.

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Area of Science:

Vascular Medicine
Hematology
Cardiology

Background:

A 50-year-old woman with a history of fetal death presented with lower limb pain, asthenia, and arthralgia.
Initial investigations revealed anemia, thrombocytopenia, elevated C-reactive protein, and high d-dimer levels.

Observation:

Compression ultrasonography confirmed bilateral calf vein thrombosis.
Following initiation of low-molecular-weight heparin for anticoagulation, the patient developed dyspnea, chest and abdominal pain, and fingertip necrosis.
Laboratory tests showed acute kidney injury, proteinuria, and elevated troponin levels, indicating cardiac involvement.

Findings:

The patient presented with deep vein thrombosis (DVT) complicated by potential pulmonary embolism and cardiac injury.
Imaging studies, including contrast-enhanced CT and cardiac MRI, were performed to further evaluate the extent of the condition.

Implications:

This case underscores the importance of vigilant monitoring for complications in patients with DVT, particularly those with risk factors.
Prompt diagnosis and management of DVT and its sequelae are crucial for patient outcomes.