Yep! So the patient was taken off ace for cough and amlodipine due to leg swelling. They tried hydralazine and it led to an increase in ptt. They measured all the factor levels, factor 8 was down to 30%. Positive lupus anticoagulant, positive ana, dsdna, reduced c3, c4. positive thyroid perox autoab. histone antibody positive as well pointing to drug induced.
So even though this patient has a high ptt, they are hypercoagulable. Do they need anticoagulation? I didn't think so especially because this case can have significant blood loss but it's a consideration.
I didn't do a nerve block but I did skip the spinal. I put in an lma and she did fine. I think as long as they don't have postural symptoms, lma is well tolerated even in lateral position. However, putting a fascia iliaca or even femoral nerve block in with a ptt of 57 is okay. Superficial, compressible site.
Props to blockit for pointing out the ptt early although he graciously removed his post so the trainees can look at the case first.