• Mrs. JN is a 32 year-old secretary who is having increasing difficulty typing because of joint stiffness.
• She now has left calf swelling and tenderness.
• She's had two miscarriages in the past two years.
• She has a four year-old daughter.
• Her maternal grandmother died at age 38 of what is described as a clot in the lung.

• Physical exam reveals a slightly enlarged left calf as compared with the right.
• There is mild calf tenderness to palpation.
• Chest is clear to auscultation. Heart sounds are normal. BP = 110/68 mmHg
• Initial labs:
• PT = 11.4 seconds (reference = 11.2 seconds)
• aPTT = 48 seconds (reference = 24-34 seconds)
• CBC
• Serology

Does this make any sense? Sounds like a DVT, but with aPTT prolongation?        Back