Familial antithrombin III deficiency in a Malay patient with massive thrombosis

Author: Wan Suriana Wan Ab Rahman ; Wan Zaidah Abdullah ; Mohd Nazri Hassan ; Azlan HUSSIN ; Zefarina Zulkafli ; Juhara Haron
Publication Type:Case Report
Keywords: antithrombin III; heparin; thrombophilia; thrombosis; venous thromboembolism
From:The Malaysian Journal of Pathology 2017;39(2):197-200
CountryMalaysia
Language:English
Abstract: Patients with low antithrombin III (AT III) has increased risk for arteriovenous thromboembolic (TE) disease. We report a 28-year-old Malay lady who presented with spontaneous right calf pain and swelling of one week duration. She was on oral contraceptive pills and had a history of travelling for a long distance prior to the presentation. Her brother who was diagnosed with AT III deficiency had arterial thrombosis at a young age. She was diagnosed as having right popliteal vein thrombosis by ultrasound and treated with subcutaneous fondaparinux. While on treatment, she developed massive bilateral pulmonary embolism (PE). Thrombophilia study showed reduced AT III activity (38μl/dl) and normal results for protein C, protein S, activated protein C resistance and lupus anticoagulant assays. This patient has heterozygous AT III deficiency added with significant acquired factors responsible for the TE events. Those with AT III deficiency may have resistance to heparin therapy and require higher doses of heparin.