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A complication of hip surgery

¹ Department of Cardiology, Arrowe Park Hospital, Wirral, UK
² Department of Haematology

Correspondence to:
Correspondence to:
Dr Simon G Williams, Department of Cardiology, Arrowe Park Hospital, Arrowe Park Road, Upton, Wirral CH49 5PE, UK;
drsgwilliams@hotmail.com

Submitted 12 December 2002
Accepted 20 December 2002

Keywords: hip replacement; thrombocytopenia; heparin

The first 100% of the full text of this article appears below.

A 53 year old woman presented with right sided pleuritic chest pain four weeks after a total hip replacement. Prophylactic low molecular weight heparin had been given perioperatively for four days. Clinical examination revealed a swollen tender left calf and a pleural rub at the right base on auscultation of the chest. Vascular Doppler scanning of the left leg revealed a deep vein thrombosis. A clinical diagnosis of pulmonary embolism was made and before starting the patient on low molecular weight heparin for treatment, a full blood count was performed. This revealed a haemoglobin concentration of 134 g/l, white cell count 7.6 x 10⁹/l, and platelets 17 x 10⁹/l.

QUESTIONS

1. What is the likely diagnosis?
   
2. Which test should be recommended to confirm the diagnosis?
   
3. What treatment should be offered for the pulmonary embolism?