|
|
| (52 intermediate revisions by 7 users not shown) |
| Line 1: |
Line 1: |
| {{Infobox_Disease |
| | __NOTOC__ |
| Name = {{PAGENAME}} |
| | {{Thrombophilia}} |
| Image = |
| | {{CMG}}; {{AE}} [[User:Kashish Goel|Kashish Goel, M.D.]], {{asiri}},{{M.B}}, {{MKA}}, {{S.G.}}, {{JK}} |
| Caption = |
| |
| DiseasesDB = 29080 |
| |
| ICD10 = |
| |
| ICD9 = |
| |
| ICDO = |
| |
| OMIM = 188050 |
| |
| MedlinePlus = |
| |
| eMedicineSubj = |
| |
| eMedicineTopic = |
| |
| MeshID = D019851 |
| |
| }} | |
| {{SI}} | |
| {{CMG}};'''Associate Editor(s)-In-Chief:''' [[Kashish Goel|Kashish Goel, M.D.]] | |
|
| |
|
| '''''Synonyms and Keywords:''''' Hypercoagulability, coagulability, hypercoagulable state
| | {{SK}} Hypercoagulability, coagulability, hypercoagulable state; thrombosis risk elevation; thrombotic tendency; prothrombotic state; clotting disorder; |
|
| |
|
| ==Overview== | | == [[Thrombophilia overview|Overview]] == |
| '''Thrombophilia''' means increased risk of [[thrombosis]] (blood clots) in the body, due to an abnormality in the system of [[coagulation]]. Thrombophilia can be congenital or acquired. Less than 50% of the cases of thrombosis not diagnosed with un underlying thrombophilia.
| |
|
| |
|
| ==Classification== | | == [[Thrombophilia historical perspective|Historical Perspective]]== |
| Thrombophilia can be classified in various forms.
| |
| * The most common classification is by the nature of the thrombosis: [[artery|arterial]], [[vein|venous]] or combined.
| |
| * Crowther & Kelton (2003) propose to classify the abnormality by the molecular deficiency, type I being the (severe) deficiencies of inhibitors, and type II being the less severe elevation of coagulation factors.<ref>{{cite journal |author=Crowther MA, Kelton JG |title=Congenital thrombophilic states associated with venous thrombosis: a qualitative overview and proposed classification system |journal=Ann. Intern. Med. |volume=138 |issue=2 |pages=128-34|year=2003 |pmid=12529095 |doi= |url=http://www.annals.org/cgi/reprint/138/2/128}}</ref>
| |
| * Acquired vs. congenital
| |
|
| |
|
| ==Pathophysiology== | | == [[Thrombophilia classification|Classification]] == |
|
| |
|
| ==Epidemiology and Demographics== | | == [[Thrombophilia pathophysiology|Pathophysiology]] == |
|
| |
|
| ==Risk factors== | | == [[Thrombophilia causes|Causes]] == |
|
| |
|
| ==Causes== | | == [[Thrombophilia differential diagnosis|Differentiating Thrombophilia from Other Diseases]] == |
| Common types:
| |
| * [[Factor V Leiden|Factor V, Leiden type]] (5% of the population are [[heterozygous]] for FVL).
| |
| * [[Prothrombin]] mutation (G20210A, 5'UTR).
| |
| * High [[homocysteine]] levels due to [[MTHFR]] mutation or vitamin deficiency (vitamins B6, B12 and folic acid).
| |
| * [[Antiphospholipid antibodies]]
| |
| ** [[anti-cardiolipin antibodies]] and/or
| |
| ** [[lupus anticoagulant]]s
| |
| * [[Kidney|Renal disease]] (renal loss of antithrombin)
| |
|
| |
|
| Rare forms:
| | == [[Thrombophilia epidemiology and demographics|Epidemiology and Demographics]]== |
| * [[Plasminogen]] and [[fibrinolysis]] disorders.
| |
| * [[Paroxysmal nocturnal hemoglobinuria]]
| |
| * [[Protein C deficiency]].
| |
| * [[Protein S deficiency]].
| |
| * [[Antithrombin|Antithrombin III]] deficiency.
| |
|
| |
|
| ==Differential diagnosis of thrombophilia== | | == [[Thrombophilia risk factors|Risk Factors]] == |
| (By organ system)
| |
| {|style="width:75%; height:100px" border="1"
| |
| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
| |
| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | • Cerebral vein thrombosis • Acute myocardial infarction • Deep vein thrombophlebitis • Portal vein thrombosis • Pelvic thrombophlebitis
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Chemical / poisoning'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Dermatologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Drug Side Effect'''
| |
| |bgcolor="Beige"| • Asparaginase • Bevacizumab • Combined oral contraceptive pill • Cyproterone • Diethylstilboestrol • Drospirenone • Eltrombopag • Erythropoietin • Ethinylestradiol • Fosfestrol • Granulocyte-macrophage colony stimulating factor • Heparin • Hormone replacement therapy • Lenalidomide • Peginesatide • Polyestradiol • Raloxifene • Strontium ranelate • Tamoxifen • Tobacco smoking • Tranexamic acid • Vorinostat
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Ear Nose Throat'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |- | |
| |-bgcolor="LightSteelBlue"
| |
| | '''Endocrine'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Environmental'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Gastroenterologic'''
| |
| |bgcolor="Beige"| • Acute pancreatitis • Portal hypertension
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Genetic'''
| |
| |bgcolor="Beige"| Congenital Dysfibrinogenemia • Factor II mutation • Hereditary thrombophlebitis • Antithrombin III deficiency • Factor V Leiden mutation • Protein C deficiency • Protein S deficiency • Klippel-Trenaunay syndrome • Klinefelter syndrome • Sickle cell disease
| |
|
| |
|
| • Carbohydrate-deficient glycoprotein syndrome type 1b • Factor XII deficiency • Haemoglobin SC disease • Hyperprothrombinemia 20210G-A
| | == [[Thrombophilia screening|Screening]]== |
| Normal.dotm 0 0 1 52 302 kashish85 2 1 370 12.0 0 false 18 pt 18 pt 0 0 false false false |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Hematologic'''
| |
| |bgcolor="Beige"| • Polycythemia vera • Essential thrombocythemia • Myeloproliferative disease • Hyperviscosity syndrome • Paroxysmal Nocturnal Hemoglobinuria • Thrombocytosis • Raised homocysteine levels
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Iatrogenic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Infectious Disease'''
| |
| |bgcolor="Beige"| • Intraperitoneal abscess • Acute peritonitis • Visceral abscess • Diverticulitis
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Musculoskeletal / Ortho'''
| |
| |bgcolor="Beige"| • Orthopedic surgeries • Abdominal surgery
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Neurologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Nutritional / Metabolic'''
| |
| |bgcolor="Beige"| • Cystathionuria • Homocystinuria • Methyltetrahydrofolate reductase deficiency • Metabolic Syndrome • Insulin resistance • Folic acid deficiency • Obesity
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Obstetric/Gynecologic'''
| |
| |bgcolor="Beige"| • Pregnancy • Puerperium period • Ovarian hyperstimulation syndrome | |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Oncologic'''
| |
| |bgcolor="Beige"| • Malignancy • Peritoneal metastasis • Adenocarcinoma of cecum • Adenocarcinoma of colon • Occult malignancy • Leukemia • Pancreatic cancer
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Opthalmologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Overdose / Toxicity'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Psychiatric'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Pulmonary'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Renal / Electrolyte'''
| |
| |bgcolor="Beige"| • Chronic renal failure • Paroxysmal Nocturnal Hemoglobinuria • Nephrotic syndrome
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Rheum / Immune / Allergy'''
| |
| |bgcolor="Beige"| • Antiphospholipid Syndrome • Circulatin anticoagulant • Heparin induced thrombocytopenia • Inflammatory bowel disease • Crohn's disease
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Sexual'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Trauma'''
| |
| |bgcolor="Beige"| • Trauma • Abdominal trauma
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Urologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Miscellaneous'''
| |
| |bgcolor="Beige"| • Paraneoplastic syndrome • Hypereosinophilic syndrome • Immobility
| |
| |-
| |
| |}
| |
|
| |
|
| ==Indications for testing== | | == [[Thrombophilia natural history, complications and prognosis|Natural History, Complications and Prognosis]] == |
| Searching for a coagulation abnormality is not normally undertaken in patients in whom thrombosis has an obvious other cause. For example, if the thrombosis is due to immobilisation after recent [[orthopedic surgery]], it is unlikely that an underlying cause is found.
| |
|
| |
|
| Conversely, although thrombosis itself may occur in any person, repeated (two or more) unprovoked episodes of thrombosis and unusual sites and types of thrombosis (e.g. [[Budd-Chiari syndrome]]) may point towards a coagulation disorder.
| | == Diagnosis == |
| | [[Thrombophilia history and symptoms|History and Symptoms]] | [[Thrombophilia physical examination|Physical Examination]] | [[Thrombophilia laboratory findings|Laboratory Findings]] | [[Thrombophilia x ray|X Ray]] | [[Thrombophilia CT|CT]] | [[Thrombophilia MRI|MRI]] | [[Thrombophilia echocardiography or ultrasound|Ultrasound]] | [[Thrombophilia other imaging findings|Other Imaging Studies]] | [[Thrombophilia other diagnostic studies|Other Diagnostic Studies]] |
|
| |
|
| Increasingly, [[habitual abortion|recurrent miscarriage]] is seen as an indication for thrombophilia screening. <ref>Dawood, F., Farquharson, R., Quenby, S.''Recurrent miscarriage.'' Current Obstetrics & Gynaecology, 2004; 14:247-253.</ref>
| | == Treatment == |
|
| |
|
| Tests for thrombophilia include [[prothrombin time]] and INR, [[partial thromboplastin time]], [[thrombin time]], [[fibrinogen]] levels, [[antiphospholipid antibody]] levels (IgG- and IgM-anticardiolipin, dilute Russell viper venom time and lupus anticoagulant), [[protein C]], [[protein S]] and [[antithrombin]] (both levels and activity), activated protein C resistance (APC resistance), [[factor V Leiden]] and [[thrombin|prothrombin]] mutation. Many laboratories add on various other tests, depending on local policy and guidelines.
| | [[Thrombophilia medical therapy|Medical Therapy]] | [[Thrombophilia surgery|Surgery]] | [[Thrombophilia primary prevention|Primary Prevention]] | [[Thrombophilia secondary prevention|Secondary Prevention]] | [[Thrombophilia future or investigational therapies|Future or Investigational Therapies]] | [[Thrombophilia cost-effectiveness of therapy | Cost Effectiveness of Therapy]] |
|
| |
|
| ==Treatment== | | ==Case Studies== |
| | | :[[Thrombophilia case study one|Case #1]] |
| ==References==
| |
| <references/>
| |
|
| |
|
| [[Category:Hematology]] | | [[Category:Hematology]] |
| | | [[Category:Disease]] |
| [[de:Thrombophilie]] | |
| [[fr:Thrombophilie]]
| |
| [[no:Trombofili]]
| |
| [[pl:Trombofilia]]
| |
| | |
| | |
| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |