Antiphospholipid syndrome

Question 1

Sapporo criteria for diagnosis of APLS

Answer 1

presence of clinical and laboratory criteria

Question 2

clinical criteria for Sapporo to diagnose APLS

Answer 2

Clinical criteria:

arterial or venous thrombosis

pregnancy complications>1 unexplained fetal death at >10 weeks of gestation,

>1 preterm delivery of morphologically normal infant due to eclampsia,

preeclampsia or placental insufficency

>3 consecutive unexplained spontaneous pregnancy loss at <10 weeks gestation.

Question 3

laboratory criteria for Sapporo to diagnose APLS

Answer 3

elevated titers of

anti beta 2 glycoprotein 1

cardiolipin antibodies and/or

presence of lupus anticoagulant

needs to be at least 12 weeks apart positive elevation.

Question 4

with laboratory data for APLS do you need to repeat this?

Answer 4

yes at 12 weeks again.

Question 5

Treatment of APLS

Answer 5

in the presence of VTE and during peripartum period for patients who have prior miscarriages need antithrombotic therapy such as aspirin and lower molecular weight heparin for people who are pregnant. Avoid warfarin in pregnancy.

Question 6

what is catastrophic APS

Answer 6

multisystem failure

(severe hypertension, proteinuria, acute respiratory distress syndrome and altered mental status)

Need involvement of >3 systems of organs, or tissues

development of manifestations <1 week

confirmation of histopathology of small vessel histopathology of small vessel occlusion in one or more organ tissue.

Lab confirmation of antiphospholipid antibodies (SLE, cardiolipin antibodies, and anti beta 2 glycoprotein 1 antibodies)

Question 7

what is not seen in labs with APS

Answer 7

rare to see sever thrombocytopenia or MAHA.

Question 8

young female presents acute stroke and no headache and prolonged PTT and thrombocytopenia

Answer 8

APS

Question 9

younger pts who present with stroke or venous thromboembolism without risk factors

Answer 9

think APS

Question 10

when to have indefinite VTE AC?

Answer 10

unprovoked VTE who are low moderate bleeding risk can receive indefinite anticoagulation.

Question 11

Treatment of CAPS is

Answer 11

heparin to reduce further clotting

high dose methylprednisolone and plasmapheresis with or without IVIG.

Steroids, plasmapheresis and IVIG are meant to help with reducing quantity of pathologic antibodies. It helps improve outcomes.

Heparin can be transitioned to warfarin if a patient remains stable without further evidence of thrombosis.

Warfarin is to be continued lifelong.