Age: 51.0
Sex: M
Vaccine: COVID19
Symptoms: Activated partial thromboplastin time shortened, Anti-cyclic citrullinated peptide antibody negative, Blood copper normal, Blood fibrinogen, Blood folate normal
Clinical narrative: clinically dx'd splenic vein thrombosis based on below data/presentation:  He developed Covid infection July 2020 19 March 2021 Johnson & Johnson Covid vaccine History of splenomegaly, assoc w/ pain, 17.2 cm on ultrasound 28 April 2021 up from 12.7 cm noted on 15 March 2021, it had been normal sized at 12.9 cm 8 January 2020 History of anemia dating back to 2011, with hemoglobin of 12.2 and MCV of 86 October 2020 History of thrombocytopenia dating back to 2011 with platelet count of 128 October 2020  Referral to hematology July 2021, denies chronic use of heparin or quinine or significant amounts of antibiotics in his adult life or Tylenol or NSAIDs or excess walnuts though he does like to eat nuts daily and does not take any medicinal teas of note he mentions a 3 inch clot in his spleen when he was a teenager that required an approximate 10-day stay with IV heparin, he declined splenectomy due to his history of multiple surgeries for mitral and aortic valve replacement, initially with tissue valve at 3 months old followed by mechanical valves first at 3 years old and then have been repeated as needed and he is followed by a coumadin clinic with a goal INR of 2.5-3.5 per report, also he has a history of juvenile rheumatoid arthritis, he has received blood transfusions when he had bleeding ulcers and he has never had his Coumadin goal changed that he can recall based on the spleen clot when he was younger or the GI bleed in the past related to bleeding ulcers which I also believe was when he was young, he has had a subdural hematoma in the past that I believe was spontaneous, he has had tubular adenomas noted on colonoscopy in October 2020 and he has had an upper endoscopy in 2015  Prior labs have shown immature platelet fraction normal in 2015, anticardiolipin antibodies negative in December 2011, normal white blood cell count, CMP normal in May 2021, HIV negative in 2015, hepatitis ABC panel negative in 2014, homocystine elevated at 16.2, TSH normal in March 2021, peripheral smear review normal in May 2021 per report, IgA had been elevated in 2011 but normal in 2013, he does not drink much alcohol at all, has had an ANA positive greater than 1280 but double-stranded DNA negative, he does have a family history of clots including a sister who had to give up OCPs and a grandmother who had sudden death which may have been related to a clot, he does not have any history of known malignancy or HLH or lupus or sarcoid or amyloid and has not used G-CSF and does not have known liver disease  Labs July 2021 showed white count 6.6, hemoglobin 14.9, platelet count 163, MCV 87, hepatitis ABC panel negative, copper normal, TSH normal, EBV negative, HIV negative, ferritin 74, TIBC elevated, iron saturation 14%, reticulocyte count 1.5%, folate normal, B12 428, kappa lambda ratio normal, PNH flow symmetry negative, fibrinogen 349, PTT 52, JAK2 with NexGen sequencing negative, BCR able negative, SPEP negative for M spike, RF and CCP antibodies negative  24 August 2021 ultrasound of spleen with Dopplers showed spleen now decreased back to 12.2 cm, mild heterogeneous normal sized liver with normal flow