College of American Pathologists
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  Hemostasis Thrombosis Lab Ltd.





cap today



March 2007
Feature Story

Karen Titus

Excerpted from Dr. Luper’s full report:

This patient has an elevated level of fibrinogen. Fibrinogen is an acute phase reactant and therefore the level may only be temporarily elevated. However, the literature indicates that patients who have a persistent elevation of fibrinogen at any level have an increased tendency to thrombosis. A follow-up is suggested when the patient is in a quiescent state.

There is also a positive activated protein C resistance secondary to heterozygous mutation of the factor V Leiden. This imparts a relative risk of approximately 3.5 to 5. This abnormality has been associated primarily with venous thrombosis although there are reports of arterial thrombotic episodes.

The patient also has the presence of the lupus anticoagulant. Lupus anticoagulants can be associated with both venous and arterial thrombotic problems. The relative risk is approximately 5. Occasionally, false positives can occur in the presence of anticoagulants and also in the presence of strong specific factor inhibitors. A follow-up study may be of value if clinically indicated including specific factor assays.

Karen Titus is CAP TODAY contributing editor and co-managing editor.

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