He is a pale, ill-appearing white male complaining of right lower extremity pain. Neck is notable for several .5 x 1 cm posterior nodes. Extremities with petechiae bilaterally, violaceous discoloration of the right ankle with increased circumference greater than left by 4 cm with extension to right mid-calf 2 cm. Equal lower extremity arterial pulses. In retrospect, the DIC screen probably just represented on-going endogenous fibrinolysis from the clot formed.
Clinical Pearls Make sure that the patient is bleeding in the first place.
In this case the platelet count was never low enough in the absence of trauma to account for a calf bleed. Lupus anticoagulant is not associated with bleeding despite the fact that we term it an anticoagulant. In vivo it is a procoagulant because of avidity so involves the endothelium. Historically, the term used has been lupus anti-coagulant, but this is a misnomer since the majority of patients do not have lupus. The test is also transient and so a positive result should be repeated 2 months later.