Management of antithrombin III deficiency in pregnancy: a representative case and a literature review

The work is aimed at discussing pregnancy management for the most thrombogenic genetic thrombophilia - antithrombin III (AT-III) deficiency. A detailed analysis of the literature and clinical case of pregnancy management in a patient with AT-III deficiency, pulmonary embolism and habitual history of miscarriage has been performed and presented. Patients with AT-III deficiency are at high risk for developing thrombotic and obstetric complications even despite using therapeutic doses of anticoagulants. Indications for use and modes of administration of AT-III concentrate have not been currently defined clearly. Monitoring therapy with low molecular weight heparin is largely complicated because a test for determining anti-Xa activity is AT-III-dependent. In addition to standard methods for controlling antithrombotic therapy, we used tests characterizing the dynamic blood clot parameters: thromboelastography and thrombin generation test. The peak risk resulting in both thrombotic and hemorrhagic complications in such patients occurs during period of labor and the postpartum period, when a change in the regimen of anticoagulant therapy is required with its temporary withdrawal and additional administration of AT-III concentrate.

Brucella terminal ileitis: a rare cause of intestinal obstruction about a case

Brucellosis is a bacterial zoonosis transmitted by contact with fluids from infected domestic animals, by consumption of unpasteurized milk products, or by inhalation of infected aerosols. Systemic infection has clinical manifestations from asymptomatic cases to those that are fatal. Focal infections occur in 30% of cases and affect any organ. Gastrointestinal manifestations are rare and unspecific. We reported the case of a patient with antithrombin III deficiency who presented with a clinical picture of abdominal pain at the emergency department, with failure of conservative treatment and with progression to acute abdomen, for which surgical treatment was offered, resolving the condition of intestinal obstruction and taking a biopsy that confirmed terminal brucella ileitis, antibiotic treatment and intestinal rest were indicated with successful results. Brucella terminal ileitis is an unusual manifestation of brucellosis. History of consumption of unpasteurized milk and derivatives and contact with livestock should be carefully examined in patients with acute abdomen in Brucella endemic countries. This will lead to a full and uncomplicated recovery from this disease.