Sarah Kung’u was full of hope when she joined the University of Nairobi to pursue a Bachelor’s degree in biology in 2003. She had loved sciences all along, and getting a slot to pursue a biological course was a dream come true.

However, this dream was cut short when Sarah began to develop anemia, low immunity, and depression. By the year 2008, her condition had worsened to a point where she now had blood clots that alternated between her right and left leg. All along, medical tests could not tell exactly what she was ailing from.

“I first went for a checkup at the Nairobi Women’s Hospital. Then I was referred to Kenyatta National Hospital for tests and diagnosis,” she says. At KNH, Sarah was given some medications and asked to be attending follow up clinics. Her condition did not improve. Her blood clots shifted from her legs to her lungs. “My condition deteriorated. I was admitted at the Kenyatta National Hospital for a month and diagnosed with Deep Vein Thrombosis (DVT),” she says.

In October 2008, she fell pregnant. “Getting pregnant was a welcome reprieve. It gave me something to smile about,” she says. But her happiness was short-lived. Sarah began to develop complications and was admitted at a private hospital in Thika for a month.

“I dreaded short calls because I would pass out my body proteins through urine (a condition called Proteinuria),” she says. She was put on two daily injections for a period of 16 weeks to help manage her condition and save her pregnancy. “My condition improved, but I still lost my pregnancy,” says Sarah, 44.

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In 2011, Sarah fell pregnant once again and carried the pregnancy to term with the help of a cervical cerclage. She was blessed with a baby boy. Over the next few years, Sarah tried to conceive again and lost five pregnancies and had 13 episodes of deep vein thrombosis.

In 2008, though, she gave birth to her first born daughter. “I delivered her on May 30, 2008 at 27 weeks (about six months). She was a miracle baby. She weighed 640grams. She didn’t have veins, and was fed through the umbilical cord. Although it was clear that Sarah had deep vein thrombosis, it was not until 2010 when her condition was diagnosed in Germany as Protein S and C Deficiency which is commonly associated with deep vein thrombosis and pulmonary embolism.

“I was put on medication, which included two tablets daily costing Sh. 1,600 and an injection which cost Sh. 1,800,” she says. In 2017, Sarah successfully delivered twins. “I am now a mother of three,” she says.

According to Dr. Yubrine Moraa Gachemba, a health advocate and physician at the Prime Care Heart Clinic at Nairobi Hospital, deep vein thrombosis, describes a blood clot that forms in the deep veins located mainly in the leg but also occur in other body parts such as arms and the lower abdomen.

There are two types of veins in these areas; superficial veins and deep veins. Superficial veins lie just below the skin and are easily seen on the surface. Deep veins, as their name implies, are located deep within the muscles of the extremity.

“The blood clots that form out of Deep Vein Thrombosis can be life threatening if a piece breaks off from the clot and travels through the circulation system to the pulmonary arteries,” she says. Where a clot is lodged into the pulmonary arteries, blood may be prevented from flowing properly through the lung, which decreases the amount of oxygen absorbed and distributed through the body.

Dr. Moraa says that pulmonary embolism is the major complication of deep vein thrombosis. “With signs and symptoms such as chest pain and shortness of breath, it is a life-threatening condition. Post-phlebitic syndrome can occur after a deep vein thrombosis. The affected leg or arm can become chronically swollen and painful with skin color changes around the foot and ankle,” she says.

There are certain symptoms that predispose the presence of this disease. According to Dr. Moraa, these symptoms are related to obstruction of blood returning to the heart and causing a backup of blood in the leg.

“These symptoms include leg cramps that occur mostly around the calf region, redness, pain, swelling, and warmth,” she says. With leg cramps, you are bound to feel pain that worsens when you bend your foot. Dr. Moraa says that as a Deep Vein Thrombosis patient, you may or may not have all of these symptoms, or you may have none. Also, the symptoms of this condition may mimic an infection often referred to as cellulitis.

At the same time, there are certain risk factors that may expose you to the disease. “A thrombus may form if the balance of clot formation and clot breakdown is altered significantly,” says Dr. Moraa. She further explains that this will happen out of prolonged traveling and sitting (such as in long distances buses and flights), smoking, or undergoing major surgery.

“Hormonal therapy and birth control pills, family history and being genetically predisposed to forming clots, polycythemia, cancer, obesity and pregnancy (including the 6 to 8 week period after delivery, are also risk factors,” she says.

Polycythemia involves the increased production of red blood cells. In most cases, pulmonary embolism is the most common complication that arises from DVT. In Kenya, it accounts for up to 14.2 per cent of cardiovascular mortality. The World Health Organization estimates that 25 per cent of hospital admissions and 13 per cent of deaths in Kenya are due to cardiovascular diseases.

Diagnosing DVT

Dr. Moraa says that diagnosing DVT starts from the patient’s health history, potential risk factors present, and the findings from the physical examination. Further risk stratification tools may include scoring systems that can help decide whether a DVT is likely. “If the probability of a leg thrombosis is low, a D-Dimer blood test may be ordered. If the result is negative, then in most cases no blood clot exists,” she says.

“If the D-Dimer test is positive, it does not necessarily mean that a deep vein thrombosis is present since many situations will have an expected positive result. As a result, D-Dimer testing must be used selectively. The test is used as a positive or negative predictor.”

Compression doppler ultrasound is the standard method of diagnosing the presence of a thrombosis. The ultrasound technician may be able to determine whether a clot exists, where it is located in the leg or arm, and its size.

According to Dr. Moraa the most common form of treatment for deep vein thrombosis is anticoagulation, commonly known as thinning the blood.

“This is done through medications and is intended to prevent further growth of the blood clot as well as the prevention of breakaway embolus,” she says. “The duration of treatment often depends upon the patient’s situation and the underlying medical conditions and risk factors that may have caused it.”

Tips to prevent DVT

According to Dr. Moraa, these are the steps you can take to keep DVT at bay:

1. Minimize risk factors for DVT; for example, quit smoking (especially if the person also is taking birth control pills or hormone therapy).
2. Evaluation of suitable contraception options with a qualified Medical provider
3. In the hospital setting usually DVT prophylaxis to minimize the potential for clot formation in immobilized patients is provided.
4. When traveling, it is recommended that you get up and walk every couple of hours during a long trip.

DVT risk factors

A thrombus can form if one or a combination of the following situations:

• Prolonged travel and sitting, such as long airplane flights, car, or train travel
• Birth control pills or hormonal therapy
• Major surgery
• Family history or genetic predisposition to forming blood clots
• Immobility, including prolonged bed rest due to illness or injury.
• Obesity
• Trauma or fracture to the lower leg with or without surgery or casting
• Pregnancy, including 6-8 weeks after delivery.
• Hospitalization
• Smoking
• Increased number of red blood cells (Polycythemia)
• Cancer