Thrombosis diagnostic evaluation: Difference between revisions

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Revision as of 20:27, 29 December 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]

Diagnostic Evaluation

Thrombosis Formation and Induced Ischemia

The diagnostic evaluation of thrombosis begins with history and physical examination to assess for occlusion of the tissue artery/vein in each organ and to assess for organ-specific symptoms. Clinical and para-clinical signs and laboratory findings may be used to confirm the diagnosis. Individual organ thrombosis is discussed below:

Unstable angina and MI: With thrombus formation and occlusion in the coronary arteries, cardiac pain new ECG findings (mainly ST segment changes and T wave inversions) occur. With cardiac tissue infarction (MI) specific cardiac enzymes (troponin, CK-MB) levels elevate in the plasma.

Cerebral stroke and TIA: Beside global or lateralized clinical signs and symptoms of CNS defect, CT scan, MRI and arteriography are used for the diagnosis.

Peripheral arterial occlusions: Clinical signs such as pain, claudication, weakness, paleness and coldness. The diagnosis is confirmed by arteriography.

Atrial thrombosis: There should be an underlying reason; usually a structural heart defect or arrhythmia. The diagnosis is essentially confirmed by echocardiography.

Ventricular thrombosis: The underlying cause is usually myocardial infarction, and some case reports have pointed to the role of hypereosinophilia. The diagnosis is essentially confirmed by echocardiography.

Visceral arteries thrombosis: This mainly consists renal, adrenal, mesenteric and splenic arteries. beside visceral pain and organ specific signs and symptoms, the diagnosis is confirmed by CT angiography, color -doppler sonography and/or MRI as proposed by majority of studies.

Underlying etiology

Laboratory Findings

cDNA-PCR Assays for Gene Mutations and Polymorphisms

4G/5G polymorphism of the plasminogen activator inhibitor-1 gene (PAI-1)
Cystathionine beta synthetase (CBS) CBS T833C & G919A
Factor V Leiden
Glycoprotein IIIa A1/A2 (platelet glycoprotein)
Methylenetetrahydrofolate reductase (MTHFR) MTHFR C677T
Prothrombin G20210A

Serologic (blood) Tests

Anticardiolipin antibodies (ACLA) IgG and IgM ACLA
Beta-2-glycoprotein antibodies
Antithrombin III
Factor VIII
Homocysteine
Lupus anticoagulant (LA)
Protein C
Protein S

Evaluation of Hypofibrinolysis

4G/5G polymorphism of the plasminogen activator inhibitor-1 gene (PAI-1) (requires cDNA-PCR assay for gene mutation)
Lipoprotein a (Lp a)

References

Template:WH Template:WS

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Thrombosis}}
-{{CMG}}
+{{CMG}} {{shyam}}
 ==Diagnostic Evaluation==
-===Thrombosis formation and Induced ischemia===
+===Thrombosis Formation and Induced Ischemia===
-With the occlusion of the tissue artery in each organ, organ specefic symptoms, clinical and para-clinical signs and laboratory findings my be used to confirm the diagnosis. as discussed below(Intracardia thrombosis is also discussed here):
+The diagnostic evaluation of thrombosis begins with history and physical examination to assess for occlusion of the tissue artery/vein in each organ and to assess for organ-specific symptoms. Clinical and para-clinical signs and laboratory findings may be used to confirm the diagnosis. Individual organ thrombosis is discussed below:
-Unstable angina and MI: With the thrombus formation and occlusion in coronary arteries, cardiac pain new ECG findings( mainly ST segment changes) occur and with cardiac tissue infarction (MI) specefic cardiac enzymes (Troponin, CK-MB) levels elevate in the plasma.
+Unstable angina and MI: With thrombus formation and occlusion in the coronary arteries, cardiac pain new ECG findings (mainly ST segment changes and T wave inversions) occur. With cardiac tissue infarction (MI) specific cardiac enzymes (troponin, CK-MB) levels elevate in the plasma.
 Cerebral stroke and TIA: Beside global or lateralized clinical signs and symptoms of CNS defect, CT scan, MRI and arteriography are used for the diagnosis.
@@ Line 17: / Line 17: @@
 Ventricular thrombosis: The underlying cause is usually myocardial infarction, and some case reports have pointed to the role of hypereosinophilia. The diagnosis is essentially confirmed by echocardiography.
-Visceral arteries thrombosis: Mainly consists renal, adrenal, mesenteric and splenic arteries. beside visceral pain and organ specific signs and symptoms, the diagnosis is confirmed by CT angiography, color -doppler sonography and/or MRI as proposed by majority of studies.
+Visceral arteries thrombosis: This mainly consists renal, adrenal, mesenteric and splenic arteries. beside visceral pain and organ specific signs and symptoms, the diagnosis is confirmed by CT angiography, color -doppler sonography and/or MRI as proposed by majority of studies.
 ===Underlying etiology===
 ===Laboratory Findings===
@@ Line 30: / Line 31: @@
 ====Serologic (blood) Tests====
 *[[Anticardiolipin antibodies]] (ACLA) IgG and IgM ACLA
+*[[Beta-2-glycoprotein antibodies]]
 *[[Antithrombin III]]
 *[[Factor VIII]]