Anti-Phospholipid Syndrome Flashcards
1
Q
What is required for the diagnosis of anti phospholipid syndrome?
A
Dx – lab criteria + ≥1 clinical criteria (it is a SYNDROME, hence clinical criteria is mandatory!)
- Anti-cardiolipin test: IgG/IgM against cardiolipin (a negatively charged phospholipid)
- Lupus anti-coag test via 50% mixing studies with normal serum. Should NOT be correctable when mixed same qty of normal serum (if correctable = factor deficiency instead)
- Anti-β2-glycoprotein I test: Detects Abs against β2-glycoprotein I (normally bound to phospholipids
Clinical: Thrombosis (arterial/venous) and/or recurrent miscarriages
2
Q
What are the clinical features of anti phospholipid syndrome?
A
Coagulation defect (↑ thrombosis): DVT (40%), ischemic CVA (20%)
Livedo reticularis
- Mottled reticulated vascular skin pattern
- Appears as a lace-like purplish discoloration of the skin
- The discoloration is caused by swelling of the venules owing to obstruction of capillaries by small blood clots.
Obstetric (recurrent miscarriage)
- Miscarriages: Multiple embryonic losses at <10wks, or fetal death at >10wks
- Premature birth (due to pre-eclampsia or placental insufficiency)
Thrombocytopenia
3
Q
What is the management of antiphospholipid syndrome?
A
Thrombosis
- ? Prophy: low dose aspirin/clopidogrel esp in high aPL titres
- ≥1 prev thrombosis: LT warf (but manage w lower INR)
Pregnancy: ↓ risk of miscarriage but not poor fetal growth and pre-eclampsia
- early PO aspirin and SC LMWH
