- Sometimes, part of the blood clot can break away and travel through the blood circulation system and lodge in the lungs, causing a pulmonary embolism (PE). A PE is a serious and potentially life-threatening condition, as it can prevent blood from reaching your lungs.
- Warning signs of a PE are chest pain or shortness of breath.
- Prothrombin time (PT).
- Activated partial thromboplastin time (aPTT; using a thromboplastin that is relatively sensitive to the presence of a lupusanticoagulant).
- Thrombin time and reptilase time (to detect a heparin or direct thrombin inhibitor effect, and to screen for dysfibrinogenemia).
- Lupus anticoagulant panel (to include at least two phospholipid-dependent clot-based assays that interrogate at least two ofeither the intrinsic [sensitive aPTT], extrinsic [dilute prothrombin time] or common [Russell's viper venom clotting time, Ecarin/Textarin clotting times] procoagulant pathways, along with mixing studies to show inhibition and "confirm" studies [e.g., platelet neutralization procedure, hexagonal phase phospholipid] to show phospholipid-dependentinhibition).
- Anti-cardiolipin and anti-?2 glycoprotein 1 antibodies (IgG and IgM isotypes).
- Activated protein C (APC)-resistance ratio (second generation; "factor V-deficient plasma" mixing study).
- Fibrinogen, soluble fibrin monomer complex and quantitative plasma fibrin d-dimer (to screen for intravascular coagulation andfibrinolysis [DIC]).
- Prothrombin G20210A mutation genotyping (direct genomic DNA mutation testing).
- Plasma homocysteine (basal).
- For patients with idiopathic or recurrent venous thromboembolism; a first episode of venous thromboembolism at a "young" age;a family history of venous thromboembolism; venous thrombosis in an unusual vascular territory; neonatal purpura fulminansor warfarin-induced skin necrosis:
- Anti-thrombin activity (followed by anti-thrombin antigen level if the activity is low).
- Protein C activity (followed by protein C antigen level if the activity is low).
- Protein S activity (followed by free protein S antigen level if the activity is low. The total protein S antigen level may behelpful if the free protein S antigen is low).
- Flow cytometry for paroxysmal nocturnal hemoglobinuria [PNH].
- Plasma ADAMTS-13 activity (for acquired or familial thrombotic thrombocytopenic purpura).
- Plasminogen activity (for ligneous conjunctivitis/gingivitis).
- Heparin-induced thrombocytopenia testing (plasma anti-PF4/glycosaminoglycan antibodies [ELISA]; platelet C-serotonin release assay; heparin-dependent platelet aggregation).
- Quantitative PCR assay for JAK-2 mutation (for splanchnic or portal vein thrombosis).
- Chest x-rayposteroanterior and lateral view, urinalysis, mammogram, CT, MRI, and respective ENT evaluation for Smokers & Tobacco users.
- Colon imaging, especially if no prior screening (proctosigmoidoscopy, colonoscopy).
- UGI/upper endoscopy.
- Abdominal imaging (CT).
- Endometrial biopsy if endometrial cancer suspected.
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