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CNSLF Path - Laboratory Dx of Connective Tissue Disorders (ii)…
CNSLF Path - Laboratory Dx of Connective Tissue Disorders (ii) Antiphospholipid Syndrome
Intro
acquired thrombophilia (prothrombotic/hypercoaguable state)
due to abs against phospholipids
clinical + lab criteria most be fulled to establish dx
may be primary or secondary to another CTD (e.g. SLE)
Clinical criteria
documented venous thrombosis (i.e. not due to long haul flight or anything else)
pul veins
IVC
Hep (budd-chiari syndrome) + portal veins
renal vein
superficial or deep veins of leg
or documented art thrombosis
cerebral arts
retinal arts
brachial arts
coronary arts (MI with no risk factors)
arts to extremities
mesenteric art
or pregnancy associated morbidity
mid to 3rd term loss
recurrent 1st trio less (3 consecutive times, as 20% of 1st tri pregnancies miscarry anyway)
severe pre-eclampsia (PET - pre-eclampsia toxaemia) requiring delivery before 36 wks
severe intrauterine growth retardation
due to clots in placenta - impaired function
Associated features (not diagnostic)
thrombocytopenia
livedo reticularis
mottled rash due to blocked vessels
white patches surrounded by red due to other vessels dilating
can be subtle
transverse myelitis (inflamm of spinal cord)
migraine
Lab criteria
lupus anticoagulant or anti-cardiolipin or anti-beta 2 gp 1
+ve on 2 occasions @ least 12 wks apart
Tx
varies with manifestation
aspirin when pregnant
lifelong anticoagulation (warfarin more effective than DOACs)