Deep vein thrombosis: a silent, but not uncommon, killer

Each year, more than 2 million Americans are diagnosed with DVT

By: Charles Wilson, Dr. Elliot Krauss and Gloria Beck
   The sudden death of NBC war correspondent David Bloom in Iraq in April 2003 stunned a nation. Mr. Bloom, 39 and healthy, died from deep vein thrombosis (DVT), apparently brought on from spending days at a time inside a cramped military tank on the front line.
   This prolonged restriction of movement caused blood to pool in the deep veins of his legs, which developed into clots, and those clots became fatal when they reached his lungs and cut off the blood supply.
   Each year, more than 2 million Americans are diagnosed with DVT, defined as clots that form in the lower legs and attach to veins. Annually, 200,000 U.S. deaths are attributed to a related condition, known as a pulmonary embolism, when one or more of these clots separates from the vein, travels through the bloodstream and ends up blocking vital blood flow to the lungs, according to the American Heart Association. The death toll from this condition is more than from breast cancer and AIDS combined.
   More commonly known as "economy-class syndrome," DVT usually occurs when a person has been sitting in one place for long periods of time, as on a 10-hour transatlantic flight in a plane’s economy seats, with limited legroom. If you are overweight or obese, live a sedentary lifestyle or have a family history of blood clotting defects, you may be at risk for DVT. Some other risks include cancer, hormone replacement therapy and birth-control medications.
   Frequently termed a "silent killer," the symptoms of deep vein thrombosis are very similar to those for muscle strain, inflammations and severe atherosclerosis, and may be overlooked. Leg pain, swelling or tightness, and muscle pain may indicate DVT, while shortness of breath and chest pain may indicate pulmonary embolism.
   Most patients who show these symptoms are admitted to the hospital through the emergency room. In the past, an ultrasound or CAT scan was needed to locate these dangerous blood clots.
   "At University Medical Center at Princeton, we use a rapid new blood test, the D-dimer, which enables us to rule out the presence of DVT and pulmonary embolism," says Dr. Elliot Krauss, chairman, Department of Pathology and Laboratory Medicine. "In certain situations, the absence of D-dimer will eliminate the need for the more expensive ultrasound, lung scan or CAT scan," he adds.
   This blood test looks for the presence of D-dimer, a byproduct of the body’s natural clotting process, which can show up from something as simple as cutting your finger or from blood clots forming in your legs.
   While the patient need only provide a blood sample, evaluating the blood requires precision, accuracy and sensitivity in the diagnostic equipment. At University Medical Center at Princeton, highly educated and skilled medical laboratory technologists are constantly monitoring the analysis being conducted.
   "Using their knowledge of science, specific information about the patient such as age, gender, ethnicity, past medical history and the results of any recent diagnostic tests, they can interpret and confirm the accuracy of the results," states Charles Wilson, administrative director, Clinical Laboratories at University Medical Center at Princeton.
   If diagnosed with DVT, the most common treatment is a blood thinner. These medications reduce the tendency of blood to clot. Treatment will vary based on the severity of the condition, and a discussion between you and your physician would be necessary.
   When traveling, you may help reduce your risk by walking down the aisle of the plane or train at least once an hour to exercise the legs. It is recommended that you avoid sleeping pills or alcohol, stay hydrated by drinking fluids, wear comfortable, loose-fitting clothing and keep your legs uncrossed. At home, it is advisable to elevate your feet above your hips when resting or sleeping.
   For more information about deep vein thrombosis, pulmonary embolisms and the D-dimer test, contact Dr. J.T. Davidson, chairman, Department of Surgery, University Medical Center at Princeton at (609) 921-7223.
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   April 24 to 30 is National Medical Laboratory Week, an opportunity to recognize the important and valuable work clinical laboratory scientists perform each day. University Medical Center at Princeton is proud to acknowledge and thank the 90 clinical laboratory professionals whose job it is to ensure that patients receive prompt, accurate and extremely high-quality test results.
Charles Wilson is administrative director, Clinical Laboratories, at University Medical Center at Princeton. Dr. Elliot Krauss is chairman, Department of Pathology and Laboratory Medicine, University Medical Center at Princeton.