An interesting case of an atraumatic painful swollen limb in a pregnant woman

Abstract

Phlegmasia cerulea dolens is an uncommon complication of deep venous thrombosis. This is associated with high rates of morbidity if not treated effectively. We present a young lady 13 weeks pregnant with one-day history of left lower limb swelling with pain and discolouration. Bedside ultrasonography revealed thrombosis occluding the common femoral vein and collateral femoral vein. She had history of neonatal alloimmune thrombocytopaenia (NAIT), and had immunotherapy previously. The safest option was to give low molecular weight heparin (LMWH) on an inpatient basis. Anticoagulation with LMWH has been well established as thromboprophylaxis during pregnancy, however, the safety profile of systemic anticoagulation is matter of debate. As highlighted in this scenario the management needs to be tailored on an individual basis. The cause for the extensive deep vein thrombosis could be possibly due to the recent immunoglobulin therapy, undiagnosed prothrombotic state (outwith pregnancy) or the procoagulant state associated with pregnancy.

1. Brockman SK, Vasko JS. Phlegmasia cerulean dolens. Surg Gynecol Obstet. 1965;121:1347-56.
2. Chaochankit W, Akaraborworn O. Phlegmasia cerulea dolens with compartment syndrome. Ann Vasc Dis. 2018;11(3):355-7.
3. Barnett D, Casey J. A case of phlegmasia cerulea dolens. Cureus. 2020;12(9):e10187.
4. Gedikoglu M, Oguzkurt L. Endovascular treatment of iliofemoral deep vein thrombosis in pregnancy using US-guided percutaneous aspiration thrombectomy. Diagn Interv Radiol. 2017;23(1):71-6.
5. Royal College of Obstetricians and Gynaecologists. Thromboembolic disease in pregnancy and the puerperium: acute management [Internet]. [London]: NICE; 2015 Apr. (Greentop guideline [No 37.b]). Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-37b.pdf
6. Linnemann B, Bauersachs R, Rott H, Halimeh S, Zotz R, Gerhardt A, et al. Diagnosis of pregnancy-associated venous thromboembolism - position paper of the working group in women's health of the society of thrombosis and haemostasis (GTH). Vasa. 2016;45(2):87-101.
7. Bates SM, Rajasekhar A, Middeldorp S, McLintock C, Rodger MA, James AH, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy. Blood Adv. 2018;2(22):3317-59.
8. Aracic N, Roje D, Jakus IA, Bakotin M, Stefanovic V. The impact of inherited thrombophilia types and low molecular weight heparin treatment on pregnancy complications in women with previous adverse outcome. Yonsei Med J. 2016;57(5):1230–5
9) Linkins LA, Dans AL, Moores LK, Bona R, Davidson BL, Schulman S, et al. Treatment and prevention of heparin-induced thrombocytopenia: antithrombotic therapy and prevention of thrombosis: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e495S-e530S.
10) Peterson JA, McFarland JG, Curtis BR, Aster RH. Neonatal alloimmune thrombocytopenia: pathogenesis, diagnosis and management. Br J Haematol. 2013;161(1):3-14.
Files
IssueVol 6 No 1 (2022): Winter (February) QRcode
SectionCase (report / study)
DOI 10.18502/fem.v6i1.7682
Keywords
Anticoagulants Neonatal Alloimmune Thrombocytopaenia Phlegmasia Cerulea Dolens Pregnancy

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Chowdhury D. An interesting case of an atraumatic painful swollen limb in a pregnant woman. Front Emerg Med. 2021;6(1):e10.

Downloads

Download data is not yet available.