RT Book, Section A1 Hillman, Robert S. A1 Ault, Kenneth A. A1 Leporrier, Michel A1 Rinder, Henry M. SR Print(0) ID 1127768823 T1 THROMBOTIC DISORDERS T2 Hematology in Clinical Practice, 5e YR 2016 FD 2016 PB McGraw-Hill Medical PP New York, NY SN 9780071626996 LK accessbiomedicalscience.mhmedical.com/content.aspx?aid=1127768823 RD 2024/03/29 AB CASE HISTORY • Part 1A 37-year-old woman presents to the emergency department with a swollen, tender left calf and dyspnea. She noted the development of symptoms 3 days ago, the day following her arrival on a plane trip from Australia to the United States. She admits to pleuritic chest pain but denies cough or fever, and has no significant past medical history. Her only medication is an oral contraceptive. She does not smoke cigarettes or use alcohol. Her parents are alive; her father takes a "blood thinner" medication for an unknown reason.Examination reveals a diaphoretic white female with tachypnea; positive examination findings include an inspiratory friction rub on the left side of the chest, a swollen left calf with a circumference 50% greater than on the right, and a positive left Homans sign. Vital signs: BP - 100/60 mm Hg, pulse - 115 bpm, resp - 26/min, temp 38°C. Pulse oximetry shows O2 saturation on room air of 92%.CBC: Hemoglobin/hematocrit - 13 g/dL/39%MCV - 88 fL MCH - 31 pg MCHC - 32 g/dLWBC count - 11,000/μL with normal differentialPlatelet count - 310,000/μLTroponin I <0.04 ng/mL (<0.04 ng/mL)Pregnancy test - negativeCoagulation studies:PT = 12.1 seconds (<14 seconds)PTT = 27 seconds (22–35 seconds)D-dimer = 1,400 ng/mL (<500 ng/mL)QuestionsGiven this history and physical findings, what diagnosis must be considered?Do the screening laboratory tests confirm this diagnosis?If not, what further workup is indicated?