Bleeding and thrombosis in a patient with primary antiphospholipid syndrome using norethisterone: a case reportReport as inadecuate




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Journal of Medical Case Reports

, 9:87

First Online: 22 April 2015Received: 18 October 2014Accepted: 20 February 2015DOI: 10.1186-s13256-015-0554-3

Cite this article as: Al Abdulhai, S.A., El-Ali, M.W. & El-Dahshan, M.ES. J Med Case Reports 2015 9: 87. doi:10.1186-s13256-015-0554-3

Abstract

IntroductionAntiphospholipid syndrome is known to be associated with the occurrence of venous and-or arterial thrombosis. There are several factors that might trigger the risk of thrombosis in antiphospholipid syndrome, including drugs, however bleeding is rare. Only a few cases of antiphospholipid syndrome have reported simultaneous bleeding and thrombosis, and only a few of these cases have reported thrombosis induced by norethisterone when used by patients with an underlying risk factor for thromboembolism.

Case presentationWe report the case of a 35-year-old Saudi woman diagnosed with antiphospholipid syndrome with a history of several spontaneous miscarriages and two previous lower limb deep vein thromboses. She had used norethisterone to postpone her menstruation and presented to our institution with severe menorrhagia. During admission, she developed thrombocytopenia, and at the same time she was found to have extensive inferior vena cava and bilateral common iliac thrombosis.

ConclusionsThis case report is of interest to rheumatologists, hematologists and radiologists because we have found that the presence of bleeding and thrombocytopenia do not preclude the concomitant occurrence of thrombotic complications of antiphospholipid syndrome. Norethisterone is normally safe to take, but it is not suitable for patients with an increased risk of deep vein thrombosis. Also, the simultaneous management of thrombosis and heavy vaginal bleeding is a challenge for clinicians since there are no evidence-based guidelines regarding the management of these patients.

KeywordsAntiphospholipid syndrome Norethisterone Bleeding Thrombosis AbbreviationsAPSAntiphospholipid syndrome

IVCInferior vena cava

aPLAntiphospholipid

VTEVenous thromboembolism

DVTsDeep vein thrombosis

PRPulse rate

BPBlood pressure

RRRespiratory rate

WBCWhite Blood Cells

HbHemoglobin

MCVMean Corpuscular Volume

MCHMean Corpuscular Hemoglobin

PTProthrombin Time

INRInternational Normalized Ratio

PTTPartial Thromboplastin Time

APCActivated protein C

ASTAspartate Aminotransferase Test

ALTAlanine Aminotransferase Test

ALPAlkaline Phosphatase

TPTotal Protein

ALBAlbumin

T.BILITotal Bilirubin

D.BILIDirect Bilirubin

LDHLactate Dehydrogenase

HCQHydroxychloroquine

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Author: Sawsan Abdullah Al Abdulhai - Mahmoud Wahid El-Ali - Mohsen El-Sherbiny El-Dahshan

Source: https://link.springer.com/







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