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Patient: sedentary behavior, calves swelling up -> ER after 2 days

Diagnosis: DVT in left common iliac vein

Risk factors: Virchow's triad

Women at high risk: contraceptive pill (estrogen) + pregnancy (higher estrogen & varicose veins & obstruction of vena cava by uterus)

Smoking -> atherosclerosis -> clot

Dehydration -> thicker blood -> more prone to clotting

In this case: sedentary behavior -> venous stasis -> clotting

Treatment: DOACs (oral anticoagulants), thrombolytics (break down fibrin cap  and platelets) but dangerous because they can lead to pulmonary embolism

Other treatments: catheterization, suction thrombectomy (risks!)

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Case 1: Factor VII deficiency

increased prothrombin time

aPTT is normal

Related parents

Less genetic variation

Higher chance of recessive disorder

In this case: recessive inheritance pattern of Factor VII deficiency

Treatment

Lifelong Factor VII administration

Vitamin K not very helpful in this case

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Coagulation cascade = series of steps in response to bleeding caused by tissue injury, where each step activates the next and ultimately produces a blood clot

Last factor: fibrin, made of fibrinogen, makes sure that all the platelets are combined, the little 'net' that holds the platelets together

Pathways

Intrinsic: because of intrinsic factors such as Factor XII

Extrinsic: happens because of extrinsic factors such as cuts, certain proteins, foreign bodies

Factor X connects the intrinsic and extrinsic pathways to  each other

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Coagulation cascade- simplified (lecture) 

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Coagulation cascade- simplified (lecture) 

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Tissue damage -> TF is exposed -> binds to factor VII -> forms a complex

The complex activates factor X, IX, V and VIII

Protein C and S (its cofactor) has inhibitory effect on factor V & VIII

Fibrinolysis

breaks down fibrin and fibrinogen

by plasmin

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vitamin K is required to activate certain factors, e.g. VII, II, IX, X