Antithrombin III deficiency is a commonly observed hypercoaguable state. Which of the following statement(s) is/are true concerning this condition?

a. A patient with this deficiency usually presents with thrombosis while on heparin or exhibits an inability to become adequately anticoagulated with heparin

b. This deficiency may be either congenital or acquired

c. Thrombotic episodes are related to predisposing events such as operations, childbirth, and infections

d. Treatment involves acutely the administration of fresh frozen plasma followed by long-term treatment with Coumadin

 Antithrombin III deficiency accounts for about 2% of venous thrombotic event. This deficiency has been described in patients with pulmonary embolism, mesenteric venous thrombosis, lower extremity venous thrombosis, arterial thrombosis, and dialysis fistula failure. Antithrombin III is a serine protease inhibitor of thrombin and factors Xa, IXa and XIa. Because one of the main actions of heparin is to potentiate the anticoagulant effects of antithrombin III, a patient with this deficiency usually presents with thrombosis while on heparin or exhibits the inability to become adequately anticoagulated with heparin. This deficiency may be either congenital (1n2000–5000 births) or acquired. Acquired defects occur with inadequate production, as in liver disease, malignancy, nephrotic syndrome, disseminated intervascular coagulation, malnutrition, or increased protein catabolism. Thrombotic episodes are related to predisposing events such as operations, childbirth, and infections. Once the diagnosis of antithrombin III deficiency is established, fresh frozen plasma should be administered followed by long-term treatment with Coumadin.