How do you form thrombi?
It’s called, well, in Pathology,
we have Virchow’s triad.
In Virchow triad,
there are three possibilities or three situations,
in which you are then going to facilitate thrombi formation.
That include, well,
we had one discussion in great detail.
Oh my goodness,
and that was when endothelial cell was damaged.
Vessel injury, you'll form a thrombi.
What if the blood just remains or it’s in a state of turbulence?
you may have a DVT
and there you are remaining static,
or a atrial fibrillation,
trouble in the blood flow on the left atrium.
Aren’t you then at risk of developing a thrombi?
Of course you are.
It's the second possibility or thirdly,
I just went through a list with you in the previous discussion,
with the picture of going through hypercoagulable situations.
Including Factor V Leiden prothrombin 20210,
or anti-thrombin three that’s being lost
and there's something else that will be coming up shortly
in which we will then call antiphospholipid syndrome.
These are the three major situations
part of your Virchow’s triad,
that are facilitating thrombi formation.
Under vessel injury:
trauma, surgery, inflammation
could result in vessel injury in thrombi formation.
What is the common denominator in all those?
Endothelial cell damaged.
What’s being expressed again from the subendothelial collagen?
Von Willebrand factor.
And the patient that I gave you is a lady,
who may have been on a long plane flight,
immobilized or pre-surgery.
Anyone who's laying there for a long period of time.
Blood stasis developing a DVT.
Varicose veins, completely different from DVT.
What are varicose veins?
or could you form a thrombus?
It’s called stasis dermatitis.
What's the risk of going on to a PE please with varicose veins?
Oh, very, very low, right?
'Cause you would have to then move the thrombi
and embolize it from the superficial saphenous
to the deep vein and then up towards your pulmonary vasculature.
Could it occur?
Sure, but low risk.
Under blood stasis maybe CHF,
let’s say that two weeks have gone by.
Two weeks after an MI have gone by.
After two weeks of an MI gone by,
then you have possibility of a true aneurism developing.
Notice I didn't say about 3 or 14 days or such.
I gave you little bit later
about two weeks and thereafter,
Once you form that true aneurism,
there’s every possibility once again with blood statis
that you may then form a thrombi.
you know the treatments,
for example, you've heard of mural thrombi.
Is the fact that you would give an anticoagulant
For example, you have a patient that has a M spike.
On serum protein electrophoresis.
In other words, a gamma wave has not become a gamma spike.
But this time you find
that the patient has elevated levels of IGM.
There’s no lytic bone lesions and we have lymphadenopathy.
Welcome to Waldenstrom’s macroglobulinemia.
Condition in which you have too much IGM
resulting in more commonly hyperviscosity
or a JAK2 step type of mutation
in which now,
the patient complains about taking hot bath
and during the hot bath is having pleuritis.
Welcome to polycythemia vera,
where the muscles
upon exposure to the hot environment degranulate,
lease histamine and cause pleuritis.
the risk factor for thrombi formation.
Hypercoagulable, under this acquired maybe malignancies
Remember, you have a young lady.
unbeknownst to her,
she’s been taking oral contraceptive pills
that might be unfortunately filled with estrogen.
There's every possibility
that she may then develop acquired DVT or hereditary.
we talked about those in which you are deficient
of those anti-coagulants.
The types of thrombosis include the following.
These will be the large veins
but these are bit deep down.
Maybe popliteal, femoral
a little bit higher up that will be scary.
Pulmo emboli is a consequence of a DVT
and the thrombosis at unusual sites.
Maybe you have a patient that does have polycythemia vera.
and ends up developing a thrombi in the hepatic vein
What do we call this again?
Budd-Chiari or will take a look in a little bit,
whenever there's thrombi formation taking place,
you could have a lady that have a recurrent,
spontaneous abortions and that's just sad.