Contributed by Malini Srinivasan MD and Franklin A. Bontempo MD
Published on line in November1999
PATIENT HISTORY:
A 36 years old male presented to the emergency department in an altered state of consciousness. The drug and alcohol screens were negative. MRI of the brain revealed a left basal ganglia infarct. CT scan with contrast revealed a short segment of thrombus at the origin of the left internal carotid artery. EEG revealed focal slowing in the left hemisphere.
LABORATORY VALUES:
Laboratory tests to rule out a hypercoagulable state revealed the following:
Factor V Leiden mutation | NEGATIVE |
Factor II (prothrombin) 20210 A variant | NEGATIVE |
Antithrombin III-A | 105 | 80 - 120 %N |
Protein C | 124 | 70 - 140 %N |
Protein S | 101 | 60 - 145 %N |
Plasminogen | 115 | 80 - 150 %N |
Antiplasmin | 105 | 80 - 120 %N |
VALUES | REFERENCE RANGE | |
Prothrombin time | 12.6 seconds | 11.5 - 15 seconds |
International normalized ratio | 0.9 | - |
APTT | 37.2 seconds | 26 - 36 seconds |
APTT mix | 37 seconds | 26 - 36 seconds |
Thrombin time | 19.4 seconds | 16 - 23 seconds |
Fibrinogen | 345 mg/dl | 160 - 460 mg/dl |
Factor X | 0.91 U/ml | 0.60 - 1.40 U/ml |
Factor VIII | 1.85 sec | 0.5 - 1.5 U/ml |
HEX LIP | POSITIVE | NEGATIVE |
DRVV ratio | 1.0 | 0.7 - 1.1 |
TTI (1:50) | 1.1 | 0.9 - 1.5 |
TTI (1:500) | 1.2 | 0.9 - 1.5 |
ACA IgG | 6.6 GPL | 0 - 23 GPL |
ACA IgM | 2.4 MPL | 0 - 11 MPL |
APTT: Activated partial thromboplastin time; DRRV: dilute Russell viper venom ratio; HEX LIP: Hexagonal lipid neutralization test; TTI: Tissue thromboplastin inhibition index; ACA: Anticardiolipin antibody.