Case Number 5
Sudarshini was a 50 year old female of Asian race . She was a married housewife with 4 children and they lived in Parklands , Nairobi . On 8th May 2021 , while in the bathroom , she developed weakness , dizziness , nausea , vomiting and breathlessness . An ambulance was called and they tried to resuscitate her without success . Two weeks prior , she sprained her left leg and developed a fracture which was managed by placement of a plaster , which she still had . Post mortem findings included a large blood clot within the pulmonary artery and the deep veins in the left calf muscles , ( this is the leg which had the fracture and where the plaster had been placed ).
Pulmonary Thrombo- Embolism
Pulmonary Thrombo-Embolism is the blockage of pulmonary artery or one or more of the arteries in the lungs . This is as a result of movement of blood clots from the veins in the legs or in rare occasions from other parts of the body . The result is failure of blood to reach the lungs in order to get a fresh supply of oxygen , suffocating the victim and may lead to sudden death .
Normally , blood is found in liquid form while flowing through the blood vessels . In this form , it is able to efficiently perform its functions which include circulation of nutrients and oxygen among others . Blood also carries with it cells used to fight infections and those that help in healing of injuries caused by trauma or by disease process .
When one gets an injury , for example a cut on the surface of the body , there is loss of blood through the injured part . The body meanwhile start its duty in ensuring that this blood loss is stopped or is kept at a minimum . It does so be recruiting some particles found in blood called platelets . These platelets are assisted by clotting factors . Through team work , they form a mesh around the wound , plugging it , leading into the reduction or stoppage of blood loss .
There are however some conditions in which blood may start forming clots while within the blood vessels . These conditions include injuries like bone fractures , injuries to blood vessels , to muscles or to other tissues ; long period inactivity which may be due to long distance travel where one may sit for long in a plane or a car ( as was seen in case number 2 above in which John , is an uber driver and his work involves sitting for long periods of time , hence predisposing him to formation of blood clots ) or even lying-in bed for many days in persons who are ill .
There are also medical conditions which may put one at a risk of formation of blood clots and these include cancers , genetic blood clotting disorders and abdominal tumours including large fibroids in females . Persons who are obese , those living sedentary lifestyle as well as females using oral contraceptives , those on oestrogen replacement therapy or are pregnant are also at a risk of developing blood clots . The risk of forming blood clots is also higher in females than in males due to their hormonal makeup .
Symptoms of the disease varies . One may complain of swelling on one or both legs which may or may not be accompanied by pain . If there is pain , it may vary from mild ( which one may ignore ) to severe and excruciating . This swelling or pain occurs when the clot is still within the veins of the lower limbs . The pains and swelling have in some cases been ignored with devastating consequences .
Other symptoms may include fainting episodes , dizziness , chest pains which may also vary from mild to severe , difficulty in breathing or weakness . At this stage , the blood clots would have migrated to the pulmonary artery or to the arteries in the lungs . When having these symptoms , it is necessary for one to reflect on whether they have the aforementioned risk factors .
Some persons who are unlucky may collapse and die suddenly as seen in case number 3 above . In the mentioned case , the deceased had never complained of any illness , neither had she ever visited any hospital for treatment but was found dead in bed , even though she had the risk factors including gender and obesity .
Having a blood clot is not a death sentence . It is a condition which can be prevented and if one is diagnosed with a blood clot , it can be managed . Be advised that you should not wait until it is too late . Once you develop symptoms or are diagnosed , you should seek medical intervention as soon as possible .
There have been cases in which clinicians have missed the diagnosis of Pulmonary Thrombo-Embolism with fatal consequences . This is because blood clots in the lungs may present with non-specific symptoms , like in case number 4 above , where clinicians missed the diagnosis of blood clot and were treating Zacharia for asthma and allergies resulting in a fatality .
In people with risk factors such as recent surgeries , injuries , persons diagnosed with deep vein thrombosis , varicose veins , persons with a kin who have died suddenly or have died from blood clot related diseases , it is important to draw the attention of the clinician to that fact . This will help the clinician formulate appropriate investigation and treatment plan which will lead to improved general well-being of the patient . When in doubt of the treatment being administered by a particular doctor , it never hurts to seek a second opinion from a different doctor .
Persons at a risk of developing blood clots are also advised to avoid smoking cigarettes . Cigarette smoking destroys blood vessels , making it easy for blood clots to form . We also know that smoking has many other negative effects in the body and hence should be avoided all together . There is also need for regular exercise , reduction of drinking of alcohol and avoidance of oral contraceptives .
In situations where you find yourself traveling in long haul flights , it is important to make frequent walks in the plane . Avoid sitting for the whole duration of the flight as this increases your risk of developing blood clots . Walking aids in preventing blood clots by contraction of muscles of the lower limbs which pumps blood towards the heart for circulation .
In conclusion , I have seen many cases which are clearly preventable and by following the above-mentioned advices , we will be able to help reduce mortality due to Pulmonary Thrombo-Embolism .
As I was doing this article , I performed two more post mortems of persons who died due to Pulmonary Thrombo-Embolism so I am querying if the increased incidences that I have noted have a direct relation with Covid-19 disease !
Note : These are real cases . However , the names and the residences have been made fictitious for the purpose of confidentiality , privacy and dignity of the deceased .
Dr . Johansen Oduor , MBChB ( UoN ), MMed Path ( UoN ), Dip for Med ( College of Medicine South Africa ), is a Forensic Pathologist and President Emeritus , African Society Forensic Medicine . You can commune with him via mail at : Johansenoduor @ gmail . com .