Evaluation of Protein C and Protein S in Young Patients with Thrombosis

Abstract

Objective: The current study aims to evaluate protein C and protein S levels in young patients with thrombosis and compare our results with others in surrounding countries. Methods: Themeasurement of protein C, total protein S, and free protein S were done for one hundred young patients (younger than thirty years) who had thromboembolic disease either deep venous thrombosis (DVT), pulmonary embolism (PE), acute myocardial infarction (AMI), or stroke who were referred to Ibn-Sina and Al-Salam Teaching Hospitals in Mosul between December 2009 and December 2011. The diagnosis was confirmed by ultrasound with Doppler, magnetic resonance imagining (MRI), electrocardiography (ECG), cardiac enzymes, and angiography according to the case. Family history was taken to establish a familial occurrence of thrombosis. The measurement was done by enzyme linked immunoassay using kits from HELENA. Results: Protein C deficiency was detected in 4 cases (4), female to male ratio was 3:1, and their ages ranged from 16 to 28 year with a mean of 21 years. About 50 of the protein C deficient patients were presented in the form of deep venous thrombosis, 25% as stroke and 25% as acute myocardial infarction. Free protein S deficiency was detected in 6 cases (6), with female to male ratio of 1:1. Their ages were in the range of 14-30 years with a mean of 22 years. About 33.3 of the protein S deficient subjects had repeated deep venous thrombosis, 33.3 had pulmonary embolisms, 16.7had strokes, and 16.7had deep venous thrombosis and pulmonary embolisms. Conclusions: It appears from this study that protein C and protein S deficiency play a role in young patients with thromboembolic disease. Screening tests for PC and PS should be done in young subjects less than thirty years with thromboembolic disease in our locality because the diagnosis of these deficiencies has a clinical implication for the prevention of recurrent thromboembolic illness. The incidence was comparable to the surrounding areas.