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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] + + - + + + - - -

Increase in PTT after administration of heparin

-
  • 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[2][3] + + + + + + ↑
  • Inactivates factor Va and factor VIIIa
Protein C deficiency[4] + + - + + +
  • Protein C functional assay
  • 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
Protein S deficiency[5] + + - + + +
  • 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)
Prothrombin gene mutation
Disseminated intravascular coagulation (DIC)[6][7] + + +/- + + + ↓ ↑ ↑ ↑ 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. ↑ 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.
  3. ↑ 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.
  4. ↑ 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)
  5. ↑ 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)
  6. ↑ Venugopal A (September 2014). "Disseminated intravascular coagulation". Indian J Anaesth. 58 (5): 603–8. doi:10.4103/0019-5049.144666. PMC 4260307. PMID 25535423.
  7. ↑ Makruasi N (November 2015). "Treatment of Disseminated Intravascular Coagulation". J Med Assoc Thai. 98 Suppl 10: S45–51. PMID 27276832.

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