Labs

The following is the complete blood count (CBC) at the time of admission:

What’s what: WBC, white blood cell count; Hb, hemoglobin; MCV, mean cell volume; MCHC, mean cellular hemoglobin concentration; RDW-SD, red cell distribution width-standard deviation; platelets, PLT; Normal values: WBC 5-10 x 10⁹/L, RBC 4-6 x 10¹²/L, Hb 12-16 g/dL, Hct 35-47%, MCV 80-100 fL, MCHC 32-36 g/dL, RDW-SD < 45 fL, platelets (PLT) 150-450 x 10⁹/L

How would you describe the CBC?

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Normal

Other labs showed normal:

• Prothrombin time (PT)
• Activated partial thromboplastin time (aPTT)
• Urea, creatinine and electrolytes
• AST, ALT, alkaline phosphate and bilirubin

Expected lab tests in portal vein thrombosis:

• May show elevations in plasma levels of acute phase reactants.
• Liver tests typically normal because hepatic arterial blood flow compensates for decreased portal inflow, although a transient, moderate increase in serum aminotransferases is seen in some patients.
• In patients with bowel ischemia, laboratory testing may reveal
  • Metabolic acidosis
  • Signs of renal or respiratory failure
  • Leukocytosis
  • Elevated hematocrit due to hemoconcentration

Which of the following imaging modalities is/are acceptable for diagnosing PVT?

The following are the imaging results from the patient:

Abdominal ultrasound:

Computed tomography angiography (CTA):

Guideline recommendations regarding diagnosis of portal vein thrombosis: