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Lessons by Volume

Thrombophilia: How To Test? How To Manage?

By Julie Hambleton, MD

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**Table 1—***Secondary Causes of Venous Thromboembolic Disease*
Abnormalities of Coagulation or Fibrinolysis
DIC, malignancy Pregnancy, estrogen use Nephrotic syndrome Lupus anticoagulant/antiphospholipid antibody syndrome
Abnormalities of Platelets
Myeloproliferative disorders: essential thrombocytosis, polycythemia ruba vera Paroxysmal nocturnal hemoglobinuria Heparin-induced thrombocytopenia
Abnormalities of the Vasculature
Hyperhomocysteinemia (which may be genetic as well) Venous stasis: immobilization, obesity, age, postoperative state Artificial surfaces: vascular grafts, central venous catheters Vasculitis Hyperviscosity syndromes (Waldenström's disease, leukostasis, polycythemia ruba vera) Thrombotic thrombocytopenic purpura

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