]> 2026-07-31T09:41:41+00:00 WBR0966 0 en Heparin induced skin necrosis ''' Correct ''' : This pateint has heparin induced skin necrosis which is not associated with thrombocytopenia. Heparin induced thrombocytopenia Warfarin induced skin necrosis Disseminated intravascular coagulation Sub therapeutic anti-coagulation ''' Incorrect ''' : Even though in this patient PT/INR are subtherpeutic, the PTT is therapeutic and hence properly anti-coagulated. Emergency Room A 62 year old woman comes to the emergency department with complaints of shortness of breath and chest pain. She was in her usual state this morning but suddenly developed these symptoms. Her past history is otherwise insignificant and her family history is unremarkable. She is a chronic smoker and smoked two packs of cigarette for the past 25 years. She occasionally consumes alcohol. She attained menopause at the age of 50 and not on any medications. Her vitals are temperature: 36.7 C, blood pressure: 140/80 mmHg, pulse: 80/min and respiration: 15/min. The patients pulse oximetry shows 92 % on 4-litres of oxygen. All system examinations are normal. V/Q scan of the chest shows high probability for pulmonary embolism. Her initial laboratory values are : Hb : 11 g/dl Hct : 37% RBC’s : 3 million/cmm WBC’s : 8000/cmm Platelet’s : 300,000/cmm PT : 13 sec (N 11-15 sec) APTT : 30 sec (N 25-40 sec) BT : 7 min (N 2-7 min) INR : 1.06 You start the patient on unfractionated heparin and warfarin. On the 3rd day, she complaints of pain in the right arm and abdomen. Examination of the right extremity reveals pale, tender arm with erythema in the abdomen that progressed quickly to hemorrhage and necrosis. A repeat CBC reveals Hb : 12 g/dl Hct : 37.5% RBC’s : 2.8 million/cmm WBC’s : 10000/cmm Platelet’s : 260,000/cmm PT : 19 sec (N 11-15 sec) APTT : 60 sec (N 25-40 sec) BT : 11 min (N 2-7 min) INR : 2 What is the most likely cause of her symptoms ? A Hematology 2020-10-28T02:13:36Z 2459150.5927778 WBR0966