Sundromes of Hypercoagulability: Protein C and Protein S Deficiencies

摘要

Imagine that you are receiving report from the night shift nurse. You are assigned a 41-year-old Caucasian female who was admitted with a second stroke. You note that the patient smoked one pack of cigarettes per day and has no history of coronary artery disease, hypertension, valvular disease, atrial fibrillation, or deep vein thrombosis. The neurologist described her condition as thrombotic strokes from an unknown origin. All routine diagnostic procedures were negative for a cerebral bleed. Your patient is on intravenous heparin, enteral feedings, and mechanical ventilation through a tracheostomy tube. Cardiac monitoring shows normal sinus rhythm. You learn that the patient is unable to move her left extremities and has a weak right hand grip. The night shift nurse concludes report by saying that a geneticist will meet with the family because the neurologist believes that the strokes were caused by a hereditary, hypercoagulable defect. When reading the patient's chart you notice that prior to admission, your patient was active and healthy, despite a previous stroke 2 years ago. According to her family, her only residual deficit was a barely noticeable fine motor weakness of her left hand. She independently cared for her two teenage children. Later, the geneticist and neurologist inform the patient's family that she has been diagnosed with Protein C and Protein S deficiencies. The neurologist briefly explains that this disorder makes her 'throw clots' and recommends that the entire family be tested for these deficiencies. After the meeting, the family turns to you for further explanations. You feel a sense of dread because you are unfamiliar with Protein C and Protein S deficiencies.