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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]

On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging
Symptoms of DVT Symptoms of Pulmonary Embolism Symptoms of Myocardial Infarction Tenderness in extremities Edema in extremities Warmth in extremities Platelet count PT aPTT Bleeding time Doppler ultrasound Chest CT scan Head CT with contrast
Antithrombin deficiency[1][2] + + - + + + - - -

Increase in PTT after administration of heparin

-
  • Should be used for diagnosis and fallow up
  • Occlusion brachiocephalic vein
  • large thrombus in superior vena cava
  • Decreased plasma antithrombin (AT III) activity
  • Nephrotic syndrome
  • Decreased inhibition of factor II and Xa
  • Antithrombin is a natural anticoagulant that is lost in the urine
Factor V Leiden mutation[3][4][5] + + + + + + ↑
  • Recommend to do weekly
  • Inactivates factor Va and factor VIIIa
Protein C deficiency[6][7][8] + + - + + + - - Normal / ↑ -
  • Hypercoagulation
  • Recurrent venous thromboembolism
  • Protein C functional assay
  • ELISA assay: may produce false positive result in cross reaction with rheumatoid factor
  • Factor VIII elevation in acute phase
  • Functional assay should not be performed if patient is on warfarin
  • Purpura fulminans (skin necrosis) could be a form of presentation
  • Risk of thrombotic skin necrosis following warfarin administration
Protein S deficiency[8][9] + + - + + +
  • Hypercoagulation
  • Recurrent venous thromboembolism
  • Protein S free antigen assay
  • Post phlebtic syndrome
  • Fetal loss
  • When performing the gold standard test, beware of interference from samples positive for Factor V mutation, protein C deficiency and oral anticoagulants (rivaroxaban)
  • Risk of thrombotic skin necrosis following warfarin administration
Prothrombin gene mutation + + - + + +
Disseminated intravascular coagulation (DIC)[10][11] + + +/- + + + ↓ ↑ ↑ ↑ N/A
  • Elevated fibrin degradation products (D-dimers)
  • Decreased fibrinogen
  • Decreased factor V and VIII
  • Shistocytes (helmet cells) on peripheral blood smear
Antiphospholipid antibody syndrome + +

References

  1. ↑ Patnaik MM, Moll S (November 2008). "Inherited antithrombin deficiency: a review". Haemophilia. 14 (6): 1229–39. doi:10.1111/j.1365-2516.2008.01830.x. PMID 19141163.
  2. ↑ Al Hadidi, Samer; Wu, Kristi; Aburahma, Ahmed; Alamarat, Zain (2017). "Family with clots: antithrombin deficiency". BMJ Case Reports: bcr-2017–221556. doi:10.1136/bcr-2017-221556. ISSN 1757-790X.
  3. ↑ Mannucci PM, Asselta R, Duga S, Guella I, Spreafico M, Lotta L, Merlini PA, Peyvandi F, Kathiresan S, Ardissino D (October 2010). "The association of factor V Leiden with myocardial infarction is replicated in 1880 patients with premature disease". J. Thromb. Haemost. 8 (10): 2116–21. doi:10.1111/j.1538-7836.2010.03982.x. PMID 20626623.
  4. ↑ Campello E, Spiezia L, Simioni P (December 2016). "Diagnosis and management of factor V Leiden". Expert Rev Hematol. 9 (12): 1139–1149. doi:10.1080/17474086.2016.1249364. PMID 27797270.
  5. ↑ Van Rooden CJ, Rosendaal FR, Meinders AE, Van Oostayen JA, Van Der Meer FJ, Huisman MV (February 2004). "The contribution of factor V Leiden and prothrombin G20210A mutation to the risk of central venous catheter-related thrombosis". Haematologica. 89 (2): 201–6. PMID 15003896.
  6. ↑ Bernard Khor & Elizabeth M. Van Cott (2010). "Laboratory tests for protein C deficiency". American journal of hematology. 85 (6): 440–442. doi:10.1002/ajh.21679. PMID 20309856. Unknown parameter |month= ignored (help)
  7. ↑ Pescatore SL (March 2001). "Clinical management of protein C deficiency". Expert Opin Pharmacother. 2 (3): 431–9. doi:10.1517/14656566.2.3.431. PMID 11336597.
  8. ↑ 8.0 8.1 Gustavo A. Rodriguez-Leal, Segundo Moran, Roberto Corona-Cedillo & Rocio Brom-Valladares (2014). "Portal vein thrombosis with protein C-S deficiency in a non-cirrhotic patient". World journal of hepatology. 6 (7): 532–537. doi:10.4254/wjh.v6.i7.532. PMID 25068006. Unknown parameter |month= ignored (help)
  9. ↑ Kristi J. Smock, Elizabeth A. Plumhoff, Piet Meijer, Peihong Hsu, Nicole D. Zantek, Nahla M. Heikal & Elizabeth M. Van Cott (2016). "Protein S testing in patients with protein S deficiency, factor V Leiden, and rivaroxaban by North American Specialized Coagulation Laboratories". Thrombosis and haemostasis. 116 (1): 50–57. doi:10.1160/TH15-12-0918. PMID 27075008. Unknown parameter |month= ignored (help)
  10. ↑ Venugopal A (September 2014). "Disseminated intravascular coagulation". Indian J Anaesth. 58 (5): 603–8. doi:10.4103/0019-5049.144666. PMC 4260307. PMID 25535423.
  11. ↑ Makruasi N (November 2015). "Treatment of Disseminated Intravascular Coagulation". J Med Assoc Thai. 98 Suppl 10: S45–51. PMID 27276832.

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