A non risk patient, female, age 45, with missing or reduced Christmas factor presented with swollen ankle and calf. She had pain in her calf, which showed the classical appearance of deep vein thrombosis, but could not clearly displayed by angiography. Biochemistry showed an increased D-dimer of 1,27, thorax CT excluded embolism, EKG was normal. How would you proceed?
First of all what is the FIX concentration? The question is whether it is muscular bleeding or a deep vein thrombosis. Ultrasound examination should be performed. In case of muscular bleeding FIX replacement should be started. In case of deep vein thrombosis LMWH treatment along with factor IX replacement should be started, depending of FIX levels. In case of thrombosis an underlying cause should be searched for (cancer?, hereditary thrombophilia?)
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