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In: Biology

CASE STUDY A 55-year-old man had an endoscopic surgery for his enlarged prostate. The surgery went...

CASE STUDY A 55-year-old man had an endoscopic surgery for his enlarged prostate. The surgery went well, and he was discharged the next day. Six days later, he presents with a painful and swollen right leg. His hemostasis screening test shows a low platelet count. The doctor suspects that the cause for his swollen leg is due to thrombosis.

Question: Discuss the possible diagnosis and its pathophysiology.

Solutions

Expert Solution

Ans.

The pirmary analysis which confirms a low platelet count and that too soon after an endosopic surgery of the prostate indicates that he is suffering from a condition called as Heparin-Induced thrombocytopenia which caused Deep vein thrombosis (DVT).

Thrombocytopenia and Deep Vein Thrombosis(DVT):

Thrombocytopenia is a condition where the count of platelets in our blood decreases below the minimum required limits.Platelets are the blood cells that help blood to clot.Thrombosis is a condition where a blockage of the veins carrying blood or a damaged blood vessel causes the blood cells to stick together and form a clot.Deep vein thrombosis occurs due to the formation of blood clots in a vein that is located deeper inside the body and usually occurs in lower leg or thigh/pelvic region, referred to as a lower-extremity thrombosis,but can also develop in upper body parts like arm or shoulder and is referred to as an upper-extremity thrombosis.

What Causes a Deep Vein Thrombosis (DVT):

The primary cause of DVT is the formation of blood clots in the veins, preventing the proper blood flow circulation in the body.This clotting of blood may be due to various reasons like:

  • An Injury - An injury can result in blood vessel damage which causes the vessel wall to narrow and block the flow of blood thereby forming a clot.
  • Surgery - During surgeries the blood vessel may damage leading to the blockage of blood through vein and formation of clots.Moreover surgery of the lower part,escpecially of the prostate etc requires a bed rest or very little to no movement for a certain period of time.This may even increase the chance of developing a blood clot.
  • Medications - There are certain medicine's which can induce the chances of blood clots.For eg.heparin, the most commonly used blood thinning anticoagulant drug, is used to prevent possible blood clots while performing a surgery.Since they prevents the clotting of blood,the platelets usually remains unaffected.But when the immune system triggers a response to this drug heparin,it results into a heparin-induced thrombocytopenia.

In the case study above, the reason for developing DVT in the patient is due to heparin induced thrombocytopenia which resulted in formation of deep vein thrombosis in the lower extreme part of the body where the operation for prostate gland enlargement was carried out. DVT will exhibit obvious symptoms of sudden swelling,pain or tenderness on the area affected.

Treatment of heparin-induced thrombocytopenia:

The treatment includes giving alternative type of anticoagulant drugs like direct thrombin inhibitors or fondaparinux.


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