Name
ANTIPHOSPHOLIPID ANTIBODY SYNDROME - SECONDARY
DESCRIPTION
DETAIL
IS ASSOCIATED WITH VENOUS, ARTERIAL THROMBOSIS OR AUTOIMMUNE THROMBOCYTOPENIA & IF ASSOCIATED WITH PREGNANCY THEN WITH FETAL LOSS. D.D. : - PT WITH THROMBOSIS SHOULD BE EVALUATED FOR HYPERCOAGULABLE CONDITIONS: DEFICIENCIES OF PROTEIN C, PROTEIN S, ANTITHROMBIN III & PLASMINOGEN RESISTANCE - CORONARY ARTRY DISEASE - ATHEROSCLEROTIC MI - ATRIAL MYXOMA - INFECTIVE ENDOCARDITIS - VALVULAR DISEASE* LUPUS ANTICOAGULANT ANTIBODIES ( IGG ) - MEDIUM TO HIGH + * ANTI-CARDIOLIPIN ANTIBODIES ( IGM ) - MEDIUM TO HIGH + * ANTI-PHOSPHOLIPID ANTIBODIES - POSITIVE * OTHER POSITIVE AUTOANTIBODIES INCLUDE - ANA, ANTI-DNA ANTIBODIES ( SINGLE OR DOUBLE STRANDED ), ANTI-B2GPI. * Hematologic and serologic manifestations of APS are as follows: For antinuclear factor, the range is 0-94.9. For lupus erythematosus cells, the range is 75.7-82. For leukopenia with 5000 cells/mm3, the range is 0-66.9. For leukopenia with 4000 cells/mm3, the range is 0-45.7 For gamma globulin at 1.6 g/dL, the range is 0-77. For rheumatoid arthritis latex, the range is 0-57. For thrombocytopenia, the range is 7-26. For a positive result from the Coombs test, the range is 0-23.9. Patients may have positive results for autoimmune hemolytic anemia. The range for false-positive results from the VDRL test is 8.3-24. * PROTHROMBIN TIME - NORMAL OR PROLONGED * APTT - PROLONED * PLASMA CLOT TIME - PROLONGED IF CARDIAC ENVOLVEMENT THEN : * ECHOCARDIOGRAPHY MAY SHOW - VALVE THICKENING, VEGETATIONS ( LIBMAN-SACKS ) PARTICULARLY IN THE VENTRICULAR SURFACE OF MITRAL VALVE, ATRIAL THROMBI, VENTRICULAR ENLARGEMENT, MYOCARDIAL DYSFUNCTION, MITRAL REGURGITATION, AORTIC REGURGITATION ( LESS FREQUENTLY ), PERICARDIAL EFFUSION & PULMONARY ARTRY PRESSURE
TYPENOTES
TREATMENT : - AVOID OR TREAT ANY OTHER RISK FACTOR, SIUCH AS HYPERTENSION, HYPERCHOLESTEROLEMIA, SMOKING & SEDENTARISM. - PT WITH SIGNIFICANT THROMBOTIC EVENTS ARE IDEAL PATIENT FOR LONG TERM ANTICOAGULANTS LIKE WARFARIN. - TREATMENT OF ASYMPTOMATIC PATIENTS HAS NOT BEEN DEFINED, BECAUSE ONLY 10 - 15% WILL DEVELOP LIFE THREATENING EVENTS. DRUGS : 1 - ANTICOAGULANTS - - UNFRACTIONATED HEPARIN - LOW MOLECULAR WEIGHT HEPARIN - ORAL ANTICOAGULANTS 2. ASPIRIN 3. CORTICOSTEROIDS : UNCERTAIN ; RESERVED FOR THE TREATMENT OF UNDERLYING COMBINED CONDITIONS LIKE ACTIVE LUPUS. 4. IMMUNOSUPRESSIVE AGENTS : UNCERTAIN
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
ANTI-NUCLEAR ANTIBODY TEST, COMPLETE BLOOD COUNT, ANTI-DOUBLE STRANDED DNA ANTIBODY, ANTI-SINGLE STRANDED DNA ANTIBODY, ANTI-PHOSPHOLIPID ANTIBODY, ANTI-CARDIOLIPIN ANTIBODIES, IGG