By Mick Kleber, Spotlight Health
With medical adviser Stephen A. Shoop, M.D.

The tragic loss of NBC correspondent David Bloom last week in Iraq put three deadly letters in the health headlines - DVT.  They stand for deep vein thrombosis, a blood clot that can form in the major veins of the legs or pelvis due to prolonged periods of physical immobility. 

"If fragments of the clot break free and migrate through the bloodstream to the lungs, it can be fatal," says Victor Tapson, associate professor, Division of Pulmonary Medicine, Department of Medicine at Duke University in Durham, N.C., and co-chair of the Council for Leadership On Thrombosis Awareness and Management.  "When clots lodge in the pulmonary arteries, they can block the flow of oxygenated blood to the heart.  This is known as a pulmonary embolism."

Military doctors in Iraq cited pulmonary embolism as the cause of Bloom's untimely death.  But the beginning of the end was a DVT.

In the popular press, DVT is sometimes called "economy class syndrome" or "traveler's thrombosis" because long flights in the confinements of coach cabins have occasionally led to DVT-related fatalities.  Extended restricted inactivity causes blood to pool in the legs' deep veins, setting the stage for dangerous clotting.

Prior to collapsing Sunday morning, Bloom had ridden for hours upon hours, day after day in the specially outfitted M88 tank recovery vehicle dubbed "the Bloom-mobile" from which he broadcast on-the-move front line video that revolutionized modern war coverage.  Reporting live round-the-clock as the American armored column fought its way north across the desert toward Baghdad, he commented offhandedly on the cramped conditions, excessive heat and lack of sleep that came with the mission. 

He complained of feeling cramps in his legs.  But he never slowed down.

According to Business Week's David Balfour, who was at the scene when Bloom arrived by airlift at the 703^rd Battalion, 3^rd Infantry Division medic station, Bloom had complained of cramping behind his knee and had sought medical advice from the United States by phone three days before he died. The doctors suspected DVT and recommended proper medical attention.  But the tenacious correspondent put duty before danger and pushed on.  He took some aspirin - which can help to thwart clotting - but it was almost certainly too little too late.

While Bloom's death happened in a combat zone, according to the American Heart Association as many as two million Americans each year develop a DVT right here at home or while traveling.  Of those, about 200,000 die of a pulmonary embolism - more than AIDS and breast cancer combined.

"Most of them are already in the hospital or bedridden," says Tapson. "But many people who appear to be perfectly healthy can develop deep vein thrombosis.  That's why knowing the symptoms and risk factors of DVT is so important."

DVT risk factors

Any of these factors may put a person at risk for DVT.  The more factors, the greater the risk:

• Over 40 - probability increases with age
• Prolonged immobility or paralysis
• Surgery - especially orthopedic, pelvic and abdominal operations
• Trauma - up to 60% of patients with leg fractures
• Prior DVT
• Cancer - particularly ovarian, pancreatic, lymphatic, liver, stomach and colon
• Inherited clotting disorders
• Hormone replacement therapy and birth control medications
• Pregnancy

Medical conditions affecting mobility, such as heart failure, chronic respiratory failure and even pregnancy can also elevate risk. 

In addition, an Italian study reported in this week's New England Journal of Medicine now also links atherosclerosis - hardening of the arteries - to an increased incidence of clotting.  "A thorough medical history and evaluation of the patient's current condition by a qualified physician is required to determine the probability of developing DVT," says Tapson.

Patients facing surgery or medical conditions that will restrict their movement for significant periods of time should discuss preventive treatment (prophylaxis) with their doctors.  Different types of blood thinners (anticoagulants) may be appropriate for short-term or long-term preventive strategies and are also used to prevent growth of clots should they form, allowing the body's natural processes to gradually dissolve them.  Compression stockings, leg exercises and mobile activity also help lower the odds of DVT.

DVT symptoms

"Almost half the time, DVT strikes without warning," says Tapson. That's why it's known as a "silent killer."  Because a number of other medical problems - muscle strains, skin infections, or the inflammation of superficial veins (phlebitis) - can produce similar symptoms, imaging studies are usually necessary to confirm the diagnosis.

When symptoms do present themselves, they may include:

• Deep muscle pain
• Muscular tenderness
• Swelling or tightness
• Discoloration of the affected area
• Skin that feels unusually warm

If any of these warning signs appear, see a health care provider without delay.  Timely treatment can reduce the chances of developing a pulmonary embolism to less than 1%.   

Pulmonary embolism basics

By the time symptoms of pulmonary embolism manifest, the situation is potentially life threatening.  These may include:

• Shortness of breath
• Rapid pulse
• Sweating
• Anxiety
• Sharp chest pain that worsens with deep breathing
• Coughing up bloody sputum
• Loss of consciousness due to very low blood pressure

"Anyone who is experiencing the symptoms of pulmonary embolism needs to obtain care immediately," says Tapson.  Because the risk of passing out is high, get someone to take you to the hospital as soon as possible.

Treatment usually begins with oxygen and pain relievers if necessary.  As for uncomplicated DVT, anticoagulants are used to keep existing clots from growing and additional clots from developing until the body can naturally dissolve the clot formations.  People in danger of imminent death may need strong clot-busting drugs called thrombolytics or emergency surgery.

Unfortunately these crisis interventions were not available in time to save David Bloom.  But his death sounds a compelling alert to the terror of deep vein thrombosis.  The weapon that stops this killer is awareness of the risk factors and warning signs.

With health as with freedom, the price is eternal vigilance.

For more information on DVT, click here.

Spotlight Health is the leading creator of celebrity-featured health-issue awareness campaigns, connecting consumers with impassioned celebrities whose personal health battles can open eyes, dispel myths and change lives. Spotlight Health helps sufferers and caregivers meet the challenges of difficult health circumstances with understandable, in-depth medical information, compassionate support and the inspiration needed to make informed healthcare choices.

Created: 4/16/2003  -  Mick Kleber & Stephen A. Shoop, M.D.
Reviewed: 4/16/2003  -  Donnica Moore, M.D.