Coagulation Defects: Insights from Cardiovascular Concerns

Further inquiries regarding deficiencies in coagulation function?

Dear Dr.
Chou,
Thank you for taking the time to respond to my email sent on September 26.
Regarding your inquiry about why I underwent blood tests, I initially visited the cardiology clinic because I was diagnosed with mitral valve prolapse several years ago.
At that time, the doctor informed me that there was no medication available for treatment and advised me to avoid excessive stress, stating that there was no significant issue.
However, earlier this year, I began experiencing numbness in the fingertips of my left hand, prompting me to return to the hospital (different from my previous one).
During the consultation, I may have mentioned to the doctor that I frequently had symmetrical bruising on my limbs, which led him to perform coagulation function tests.
During my second follow-up visit, the doctor referred me to the hematology-oncology department, so I have not returned to cardiology since then.
I have a few questions I would like to ask Dr.
Chou again:
1.
Do I need to return to cardiology for further examinations (e.g., echocardiogram, electrocardiogram)? The doctor prescribed me small white tablets, which I found online seem to be sedatives.
If these are merely symptomatic medications, is it necessary for me to take them?
2.
Regarding your response on September 29, I have the following questions:
A.
What is meant by heparin contamination?
B.
What causes the development of autoimmune conditions? If it is an autoimmune issue, are there medications available for treatment?
C.
Do major hospitals in central Taiwan perform tests for coagulation factors XI and XII?

Xiao Mei, 20~29 year old female. Ask Date: 2003/09/30

Dr. Zhou Wenjian reply Cardiology

1.
If it is just a sedative, it is not necessary to take it, but if these medications help with your symptoms, then taking this medication should be beneficial for you.
2.
A.
Heparin refers to an anticoagulant commonly used to prevent blood clotting during blood draws.
If you are having blood tests in an outpatient setting, this possibility is almost nonexistent; it mostly occurs in hospitalized patients.
Since you have had repeated tests with similar results, I suspect this possibility can be ruled out.
B.
In young women, it is more common to have certain antibodies produced that can attack their own tissues and cells, leading to dysfunction, such as systemic lupus erythematosus.
If your symptoms are due to an autoimmune condition, there are medications available for treatment, but we will evaluate the risks and benefits of medication therapy before deciding whether to prescribe it.
C.
I am not sure about this point, but I expect it may not be significant.
In fact, if it is due to a deficiency of these two factors, the patient's symptoms would be very mild and would not require treatment.

Reply Date: 2003/09/30

More Info

Understanding coagulation defects, especially in the context of cardiovascular concerns, is crucial for managing patients with a history of heart conditions and symptoms like those you've described. Your situation involves a complex interplay between your previous diagnosis of mitral valve prolapse, recent symptoms of peripheral numbness, and the discovery of bruising that led to coagulation function tests. Here’s a detailed exploration of your questions and concerns.

1. Need for Further Cardiac Evaluation: Given your history of mitral valve prolapse and the recent symptoms, it may be prudent to consult a cardiologist for further evaluation. While your current focus is on hematological issues, the heart's function and structure can be affected by systemic conditions, including those that impact coagulation. An echocardiogram or ECG could provide valuable insights into your heart's current status, especially if you experience new or worsening symptoms.

2. Medication Concerns: The small white tablet you mentioned, which you found to be a sedative, may be prescribed to help manage anxiety or stress, which can be beneficial for someone with a history of heart issues. If it is indeed a sedative, it is typically used to help with anxiety that can exacerbate heart conditions. However, if you feel that it is only a symptomatic treatment and not addressing the root cause of your symptoms, it is essential to discuss this with your physician. They can provide guidance on whether it is necessary to continue this medication or if alternative treatments should be considered.

3. Understanding Heparin Contamination: Heparin contamination refers to the presence of heparin (an anticoagulant) in blood samples, which can interfere with coagulation tests. This contamination can lead to misleading results, suggesting a bleeding disorder when there may not be one. It is essential to ensure that blood samples are collected and handled correctly to avoid such issues.

4. Autoimmunity and Coagulation: Autoimmune conditions can lead to the body mistakenly attacking its own tissues, including components of the coagulation system. This can result in various symptoms, including bruising and clotting issues. If your condition is autoimmune in nature, treatment may involve immunosuppressive medications or therapies aimed at modulating the immune response. The specific treatment would depend on the underlying autoimmune disorder diagnosed.

5. Availability of Coagulation Factor Testing: Most major hospitals, especially those with hematology departments, should have the capability to perform tests for coagulation factors, including factors XI and XII. These tests are crucial for diagnosing specific bleeding disorders and understanding the underlying mechanisms of your symptoms. If you are concerned about the availability of these tests, it is advisable to consult with your hematologist or inquire at the hospital where you are receiving care.

In summary, your symptoms and medical history warrant a comprehensive approach that includes both cardiac and hematological evaluations. It is essential to maintain open communication with your healthcare providers, ensuring that all aspects of your health are considered. Regular follow-ups and appropriate testing will help in managing your conditions effectively. If you have further concerns or symptoms, do not hesitate to seek immediate medical attention.

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