Sandbox:khurram

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]

On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].

Diseases	Clinical manifestations						Para-clinical findings				Gold standard	Additional findings
	Symptoms			Physical examination
							Lab Findings		Imaging
	Symptoms of DVT	Symptoms of Pulmonary Embolism	Symptoms of Myocardial Infarction	Tenderness in extremities	Edema in extremities	Warmth in extremities	PT	aPTT	Doppler ultrasound	Chest CT scan
Antithrombin deficiency	+	+	-	+	+	+	Normal	Normal Reduces the Increase in PTT after administration of heparin	Should be used for diagnosis and follow up	Occlusion of brachiocephalic vein Large thrombus in superior vena cava	Decreased plasma antithrombin (AT III) activity	Nephrotic syndrome Decreased inhibition of factor II and Xa Antithrombin is a natural anticoagulant that is lost in the urine
Factor V Leiden mutation	+	+	+	+	+	+	N/A	↑	Recommended to do weekly Proximal DVT is more commonly observed as compared to distal DVT	Pulmonary embolism	N/A	Inactivates factor Va and factor VIIIa
Protein C deficiency	+	+	-	+	+	+	Normal	Normal / ↑	Hypercoagulation Recurrent venous thromboembolism	Venous thrombosis Pulmonary embolism Arterial thrombosis(rarely)	Protein C functional assay ELISA assay: may produce false positive result in cross reaction with rheumatoid factor	Factor VIII elevation in acute phase Functional assay should not be performed if patient is on warfarin Purpura fulminans (skin necrosis) could be a form of presentation Risk of thrombotic skin necrosis following warfarin administration
Protein S deficiency	+	+	-	+	+	+	Normal	Normal / ↑	Hypercoagulation Recurrent venous thromboembolism		Protein S free antigen assay	Post phlebtic syndrome Fetal loss When performing the gold standard test, beware of interference from samples positive for Factor V mutation, protein C deficiency and oral anticoagulants (rivaroxaban) Risk of thrombotic skin necrosis following warfarin administration Suspected in patients with a strong family history of VTE
Prothrombin gene mutation	+	+	-	+	+	+	↑	N/A	Proximal DVT is more commonly observed as compared to distal DVT		Detection of mutation using restriction enzyme and PCR DNA testing for prothrombin G20210A mutation	Mutation causes increased production of prothrombin Increased blood levels of prothrombin lead to venous clots in the circulatory system Hormonal oral contraceptive pills can increase the risk of VTE
Disseminated intravascular coagulation (DIC)	+	+	+/-	+	+	+	↑	↑	Portal vein thrombosis is observed in patients with coexistent hepatitis B		N/A	Elevated fibrin degradation products (D-dimers) Decreased fibrinogen Decreased factor V and VIII Shistocytes (helmet cells) on peripheral blood smear Portal vein thrombosis
Antiphospholipid antibody syndrome	+	+	+/-	+	+	+	N/A	↑	Increased impedance of flow in uterine arteries at 12-20 weeks of gestation		Antiphospholipid antibody Anticardiolipin antibody Lupus anticoagulant Anti-β2GPI antibody	Both, arterial and venous thrombosis can occur History of spontaneous abortions False positive VDRL Stroke and transient ischemic attack (TIA) are most common forms of presentation of arterial thrombosis