Date:
Patient:
Reason for Visit:
Follow-up for identified Prothrombin G20210A mutation
Evaluation of new thrombotic events (blood clots)
Management plan discussion
History:
Past Medical History (PMH):
History of venous thromboembolism (VTE) (deep vein thrombosis (DVT) or pulmonary embolism (PE)) – prior blood clots are a significant risk factor
Personal or family history of recurrent miscarriages
Any major surgeries or immobilization events (increased risk of blood clots)
Medications:
Current anticoagulant medications (if any) – blood thinners used to prevent clots
Hormonal therapy (estrogen-containing medications can increase clot risk)
Social History:
Smoking history (increases clot risk)
Long periods of sitting or immobility (e.g., long flights)
Genetic Testing:
Confirmation of heterozygous or homozygous Prothrombin G20210A mutation
Presenting Complaint:
Describe the patient’s current concerns and symptoms, including onset, duration, and severity.
New symptoms suggestive of a blood clot (e.g., leg swelling, pain, redness, shortness of breath, chest pain)
If no new symptoms, inquire about any concerns or questions regarding the Prothrombin G20210A mutation.
Physical Exam:
Vital Signs: Assess blood pressure, heart rate, oxygen saturation, and temperature (elevated temperature may suggest infection, a potential trigger for clots).
General: Look for signs of systemic illness (sweating, malaise).
Pulmonary: Assess for signs of respiratory distress (if PE is suspected).
Lower Extremities: If DVT is suspected:
Assess for leg swelling, tenderness, redness, and asymmetry compared to the other leg.
Homans’ sign test (pain in the calf with dorsiflexion of the foot).
Diagnostic Tests (may be ordered depending on clinical presentation):
D-dimer test: a blood test to assess for the presence of blood clot breakdown products (elevated levels suggestive of a clot, but not diagnostic)
Venous Doppler ultrasound: to visualize blood flow in the legs and identify blood clots.
Ventilation/perfusion (V/Q) scan or CT angiogram: imaging tests to diagnose pulmonary embolism (PE)
Assessment:
Clinical suspicion for new thrombotic event: Based on symptoms and physical exam findings.
Confirmation of new thrombotic event (if applicable): Requires diagnostic testing like Doppler ultrasound or imaging for PE.
Impact of Prothrombin G20210A mutation: Consider the mutation as a risk factor for thrombosis, but also evaluate other contributing factors.
Plan:
Thrombosis Treatment (if applicable):
Depending on the type and severity of the clot, treatment may involve anticoagulant medications (blood thinners) or clot-busting medications.
Referral to a hematologist for complex cases.
Thrombosis Prevention (if no new clot):
Consider the benefit of anticoagulant medications based on individual risk factors (age, medical history, family history, lifestyle).
Importance of lifestyle modifications to reduce clot risk (regular exercise, maintaining a healthy weight, avoiding prolonged sitting).
Discuss options for venous thromboembolism (VTE) prophylaxis during high-risk situations (surgery, long travel).
Genetic Counseling (may be recommended): To discuss the implications of the Prothrombin G20210A mutation for the patient and family members.
Patient education: Provide information about Prothrombin G20210A mutation, risk factors for blood clots, signs and symptoms to watch for, and importance of preventive measures.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and management of Prothrombin G20210A and potential thrombotic events.