Thursday, February 7, 2013


Two patients present with the same disease. A 60 year old man with three vessel coronary artery disease presents for a routine coronary artery bypass surgery. The surgery is uneventful until the team prepares to go onto bypass. Administration of a weight-based dose of heparin has very little effect on the patient's activated clotting time. His 25 year old daughter presents with her second episode of an unprovoked deep vein thrombosis.

Challenge: What's going on?

Image shown under GNU Free Documentation License, from Wikipedia.


Reflex Hammer said...

Antithrombin III deficiency!
(Just learned this today)

sibogox said...

Antithrombin III deficiency? resistant to usual dose of heparin cases.. but not sure if it is hereditary

Craig Chen said...

super!! i haven't seen this one clinically, but i get asked about it over and over.

This is antithrombin III deficiency.

Source: UpToDate.