A Difficult Case in Clinical Practice: Combined Polycythaemia Vera and Protein S Deficiency in a Patient with both Thrombotic and Bleeding ComplicationsCorrespondence Address :
Dr. Ashwal Adamane Jayaram,
Associate Professor, Department of Cardilogy, Kasturba Medical College, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India.
Polycythemia Vera (PV) is a chronic myeloproliferative disorder which is characterised by a high risk of developing arterial as well as venous thromboembolic complications like deep vein thrombosis, stroke, cortical vein thrombosis and rarely acute Myocardial Infarction (MI). PV has a risk rate of major thrombosis as high as 50%. Bleeding, thrombotic, and vascular complications are the major causes of morbidity and mortality, occurring in 40 to 60% of these patients. MI with heart failure is the most common cause of death in these patients. Congenital Protein S deficiency is an autosomal dominant disease. Venous thrombosis develops in 60-80% of patients who are heterozygous for Protein S deficiency. Hereditary Protein S deficiency is a well known risk factor not only for venous thrombosis but also for arterial thrombosis including MI and stroke. However, association of Protein S deficiency with arterial thrombosis is less appreciated. Very rarely, we find all the varied thrombotic complications in one patient. We hereby present a case who had varied thrombotic presentations due to underlying polycythemia with Protein S deficiency.
Arterial thrombosis, Myocardial infarction, Vascular complications
Sushanth Wattal, Ashwal Adamane Jayaram, Padmakumar Ramachandran, Abdul UK Razak, Suheil Dhanse. A DIFFICULT CASE IN CLINICAL PRACTICE: COMBINED POLYCYTHAEMIA VERA AND PROTEIN S DEFICIENCY IN A PATIENT WITH BOTH THROMBOTIC AND BLEEDING COMPLICATIONS. Journal of Clinical and Diagnostic Research [serial online] 2018 April [cited: 2019 Nov 15 ]; 12:OD11-OD14. Available from
Date of Submission: Jul 21, 2017
Date of Peer Review: Aug 25, 2017
Date of Acceptance: Nov 23, 2017
Date of Publishing: Apr 01, 2018
FINANCIAL OR OTHER COMPETING INTERESTS: None.
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)