Unexpected normal ROTEM results in protein C deficiency with IVC thrombosis

Area of Science:

• Hematology
• Vascular Surgery
• Clinical Coagulation

Background:

• Protein C deficiency is an inherited condition associated with an increased risk of thrombosis.
• The impact of protein C deficiency on rotational thromboelastometry (ROTEM) parameters remains incompletely understood.
• Patients with thrombotic disorders often require complex surgical interventions and monitoring.

Observation:

• A male patient in his 60s with a history of protein C deficiency and recurrent thrombotic events underwent surgical intervention for inferior vena cava (IVC) and iliofemoral vein thrombosis.
• During the procedure, rotational thromboelastometry (ROTEM) analysis was performed to assess coagulation status.
• Unexpectedly, ROTEM results, including NATEM and EXTEM assays, indicated normal coagulation, with only minor alterations in INTEM.

Findings:

• Rotational thromboelastometry (ROTEM) analysis in a patient with protein C deficiency and extensive thrombosis revealed largely normal coagulation profiles.
• Specific ROTEM parameters like NATEM and EXTEM showed no significant abnormalities, contrary to expectations for a patient with a known thrombotic risk factor.
• A slight shortening in A10 and A20 in the INTEM assay was observed, but overall coagulation function appeared preserved.

Implications:

• The findings suggest that individuals with protein C deficiency can exhibit complex and variable coagulation dynamics, potentially maintaining a balanced hemostatic state despite the underlying disorder.
• Rotational thromboelastometry (ROTEM) may not always reflect the thrombotic risk associated with protein C deficiency, indicating the need for careful interpretation in such cases.
• This case underscores the intricate nature of coagulation and the body's compensatory mechanisms in managing inherited thrombotic conditions.