Question

Leona Case Study

Leona is 52 years old and smokes. She is also overweight and has atherosclerosis. When she was given a 2-week vacation from work, she packed up her bags and flew from Minnesota to Sydney, Australia, for the trip she always wanted to take. Unfortunately, just 3 days after she arrived, she was hospitalized when her left calf became inflamed, causing her considerable pain. The physician attending to her told her she developed a deep vein thrombosis.

Student Name:

1.Explain, using your knowledge of hypercoagulability, why the trip to Australia contributed to Leona’s DVT? Why was Leona already at risk for thrombus development?

2.How does Leona’s atherosclerosis affect platelet function? Conversely, what is the effect of increased platelet activity on the development of atherosclerosis?

3.How do atherosclerosis and immobility promote changes in blood coagulation?

4.When Leona was in hospital, she received heparin therapy. Explain why this course of action was taken to treat her DVT. Why was she not given heparin tablets to take back to the hotel with her?

Answer 1

1. ANS: Leona was already suffering from atherosclerosis and overweight, her trip to Australia contributed to thrombosis developments. Atherosclerosis is basically a condition in which plaque i.e. fats, calcium, cholesterol and other substances build inside the blood vessel i.e. arteries. Arteries in principle are the blood vessels that usually transport oxygenated blood to and fro the heart and to other parts of the body. Hence this constriction of the arteries limits the flow of oxygen to the body. Hypercoagualtion on the other hand is a condition that arises when blood flowing through the body within the blood vessels clot hence this condition can increase the risk of developing blood clot within the arteries. Hypercoagualtion can be acquired or inherited; acquired hypercoagualtion is as a result of a person having cancer, recent trauma, surgery, obesity, pregnancy, prolonged rest or immobility etc. Therefore since Leona was overweight and long hours of travel played a role in her development of the deep vein thrombosis. Long hours of immobility while in her flight to Australia and the obese condition lead a condition of acquired hypercoagualtion which will result into blood clots in the Vein or venous thrombosis which essentially occurs in a deep leg vein that runs through the muscles of the thigh and the calf. The end result is an increased risk for thrombus formation. In Leona's situation, her weight and smoking habit were additional risk factors for the condition.
2. ANS: Atherosclerosis disturbs the flow of blood and damages vessel endothelium causing an increase in platelet adherence. There is also an increased sensitivity by platelets to factors that cause adhesiveness and aggregation. Adhering platelets release growth factors that enhance smooth muscle proliferation in the vessel wall. Consequently, platelet aggregation is able to contribute to the development and progression of atherosclerosis.
3. ANS: Both conditions increase coagulation. Atherosclerosis increases platelet function by encouraging aggregation and adherence. Immobility, in contrast, contributes to hypercoagulation by increasing procoagulation factors.
4. ANS: Heparin effectively encourages the inactivation of clotting factors, thereby inhibiting fibrin formation. Heparin cannot be absorbed through the gastrointestinal system and can only be administered by injection or IV infusion.