Blood clots in the veins may lead to abrupt deaths

BY RACHEAL NINSIIMA

For weeks, the universe did not seem to make sense to Musa Mugume who had sustained fractures in his legs and suffered severe bleeding from a bus accident that had occurred along Masaka road. The illness appeared not to affect his general physique but he did notice a strange symptom; that of a swelling in his left leg.

Mustering courage, he let it be massaged every day for two hours because casts had to be put on his legs. When they finally placed, pain seemed to surge beneath these fibre tight bone straighteners. However, after days on end, they were finally removed. When the orthopaedic did an ultra-scan on his legs, he diagnosed Deep Vein Thrombosis (DVT). Unbeknown to him, his life would lay motioneless and breathless in just three days. Mugume died of a deep clot in his blood.

DVT means thrombosis (clotting) of blood in the deep veins of the legs. It can cause swelling and pain in the leg, but often occurs without giving any symptoms. Dr Miriam Laker Opwonya-Oketta of the infectious disease institute says that blood clots may form abnormally when there is a reduction in the speed of the normal flow of blood in the veins, injury in the inner walls of the blood vessels and abnormalities in the substances which are responsible for forming clots.

Dr Miriam says that there are two systems of veins in the legs - the important deep veins which carry most of the blood up the legs towards the heart and the superficial veins just under the skin.She adds that a blood clot/thrombus in the deep venous system is not dangerous but may cause pain. 

“The situation becomes life threatening when a piece of clot breaks off, travels to the hearts and is pumped into blood vessels of the lings,” she says.

She adds that all the veins in the leg have valves which should direct blood flow upwards, towards the heart. The deep veins lie between the muscles, and muscular activity (moving the legs, walking, or any leg exercise) helps to pump the blood up these veins. 

When the legs are inactive, and particularly when sitting or standing, blood tends to stagnate in the deep veins. Stagnation of blood can eventually lead to thrombosis.

Dr Derrick Bengo, a haematologist (blood specialist)at Mulago hospital explains thatwhen the clot moves up to the lungs, a person might develop one of these three complications.

Pulmonary embolism.

A pulmonary embolism happens when a piece of the blood clot breaks off and travels through your bloodstream to your lungs, where it blocks one of the blood vessels.Dr Bengo says that small pulmonary emboli may cause chest pain, and sometimes coughing of blood while the multiple or larger pulmonary emboli may cause death.

“The thrombosis can get stuck and interfere with the process of gas exchange resulting into death,” he says.

Post thrombotic syndrome

This happens if the damage caused by a DVT permanently reduces the ability of your veins to efficiently return blood from your lower leg and leads to pooling of fluid. This can eventually lead to long-term pain and swelling. In severe cases these may lead to boils on your leg.

Limb ischaemia

This is a rare complication that only happens with a large DVT. The blood clot can cause the pressure in your vein to become high. “This can block the flow of blood through your arteries, so less oxygen is carried to your affected leg. This can be painful and lead to skin boils, infection and even decay,” Dr Bengo says.

Treatment of DVT

Inthe medical journal, ‘The Diagnosis of venous thromboembolism,’Kelly J and Lewis RR in advise thatanticoagulant medicines prevent a blood clot from getting bigger and also help stop part of the blood clot from breaking off and becoming lodged in another part of one’s bloodstream. There are two types of anticoagulants used in treatment of DVT. These are:

Heparins

Heparin is available in two different forms: standard and low molecular weight heparin (LMWH). Standard heparin can be given as an intravenous injection administered straight into one of your veins, anintravenous infusion where a continuous drip of heparin is fed through a narrow tube into a vein in your arm and a subcutaneous injection, administered under your skin. LMWH works contains small molecules that dissolve the clot which means you will not have to stay in hospital and be monitored.

Warfarin

Warfarin is taken as a tablet. You may need to take it after an initial heparin treatment to prevent further blood clots occurring.

“When you first start taking warfarin, you may need to have two to three blood tests a week until your regular dose is decided,” they write.

In addition, Dr Bengo advises that individuals with an excessive tendency to form blood clots, anticoagulant drugs like warfarin can be lifesaving.

Elastic compression stockings

Patients with a deep vein thrombosis should wear compression stockings as the rate of post-thrombotic syndrome may be reduced.These special stockings are designed to provide "graduated" pressure starting at the ankle and reducing pressure as the stocking goes up to the calf or thigh. By providing "graduated" compression with the greatest pressure at the ankle and reducing pressure as the stocking goes up to the calf or thigh - medical compression stockings support the weakened vein walls.

In terms of dieting, vitamin K is best known for its role in healthy blood clotting.In 1929 a Danish scientist discovered thatoften, when a person is known to have a slow blood clotting time and were given Vitamin K before surgery, it controlled excess bleeding.

The use of the letter "K" in the very name of this vitamin originally came from the German word koagulation.

“Leafy vegetableslike spinach and amaranathus containVitamin Kanthocyanins – powerful amino acids that may cut one’s risk of heart disease and stroke by inhibiting clot formation,”Grace Babughirana an expert nutritionist says.

Babughirana adds that other food sources include beef liver, chicken liver, milk and eggs and liver.

On the Knee guru website, one post reads:“I had experience with a blood clot after my surgery. It is not something that you want to mess around with. The discomfort is like a deep ache. It lessens when you elevate the leg and becomes more uncomfortable when you are upright. If you continue to be concerned- call your doctor. It's always better to be safe than sorry.”

Although its symptoms and signs do not come in handy like other ailments, DVT could be lead to sudden death like that Mugume faced.

ninsiima@observer.ug