Differentiating Antiphospholipid syndrome from other diseases: Difference between revisions
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!Thrombocytopenia | ![[Thrombocytopenia]] | ||
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!Anti-heparin-PF4 IgG | !Anti-heparin-PF4 IgG | ||
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* Serotonin release assay (SRA) | * Serotonin release assay (SRA) | ||
* Heparin induce platelet aggregation (HIPA) assays | * Heparin induce platelet aggregation (HIPA) assays | ||
* Solid-phase immunoassay (SPI) (H-PF4 enzyme-linked immunosorbent assay [ELISA]) | * Solid-phase immunoassay (SPI) (H-PF4 enzyme-linked immunosorbent assay [[[Enzyme linked immunosorbent assay (ELISA)|ELISA]]]) | ||
* Particle gel immunoassay (PIFA) | * Particle gel immunoassay (PIFA) | ||
!Stroke, pulmonary embolism, mesenteric ischemia, intraabdominal or retroperitoneal bleeding, or acute limb ischemia. | ![[Stroke]], [[pulmonary embolism]], [[mesenteric ischemia]], intraabdominal or [[Retroperitoneum|retroperitoneal]] bleeding, or acute limb [[ischemia]]. | ||
!- | !- | ||
!Schistocytes | ![[Schistocytes]] | ||
!Serotonin release assay | !Serotonin release assay | ||
!Limb gangrene | !Limb gangrene | ||
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* [[Petechiae]] | * [[Petechiae]] | ||
* Anal pruritis | * Anal pruritis | ||
!Splenomegaly | ![[Splenomegaly]] | ||
!- | !- | ||
! | !↑[[White blood cells|WBCs]], predominantly [[Neutrophil|neutrophils]] | ||
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* [[Splenomegaly]] | * [[Splenomegaly]] | ||
* Splanchnic venous thrombosis | * Splanchnic venous thrombosis | ||
! [[PET]] scan- metastasis in bone marrow | ! [[PET]] scan- [[metastasis]] in bone marrow | ||
! Terminal myeloid cell expansion | ! Terminal [[myeloid]] cell expansion | ||
!Philedelphia chromosome by PCR or BCR/ABL by FISH | ![[Philedelphia chromosome]] by PCR or BCR/ABL by FISH | ||
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* [[Bruising]] | * [[Bruising]] | ||
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!Ultrasound | ![[Ultrasound]] | ||
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!Karyotyping | ![[Karyotyping]] | ||
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!Myxedema | ![[Myxedema]] | ||
Dry skin | |||
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* Normal/ low [[Thyroid-stimulating hormone|TSH]] | * Normal/ low [[Thyroid-stimulating hormone|TSH]] | ||
* Rest of pituitary hormone levels WNL | * Rest of [[pituitary]] hormone levels WNL | ||
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! | ! |
Revision as of 20:11, 1 May 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Feham Tariq, MD [2]
Overview
Antiphospholipid syndrome should be differentiated from conditions such as hemolytic uremic syndrome-thrombotic thrombocytopenic purpura (HUS-TTP), disseminated intravascular coagulation (DIC), paroxysmal nocturnal hemoglobinuria, SLE, HELLP syndrome and other myeloproliferative diseases.
Differentiating Antiphospholipid antibody syndrome from other Diseases
- Hemolytic uremic syndrome-Thrombotic thrombocytopenic purpura (HUS-TTP)
- Disseminated Intravascular Coagulation (DIC)
- paroxysmal nocturnal hemoglobinuria
- SLE
- HELLP syndrome
- Myeloproliferative diseases
Abbreviations: ABG= Arterial blood gas, ANA= Antinuclear antibody, ANP= Atrial natriuretic peptide, ASO= Antistreptolysin O antibody, BNP= Brain natriuretic peptide, CBC= Complete blood count, COPD= Chronic obstructive pulmonary disease, CRP= C-reactive protein, CT= Computed tomography, CXR= Chest X-ray, DVT= Deep vein thrombosis, ESR= Erythrocyte sedimentation rate, HRCT= High Resolution CT, IgE= Immunoglobulin E, LDH= Lactate dehydrogenase, PCWP= Pulmonary capillary wedge pressure, PCR= Polymerase chain reaction, PFT= Pulmonary function test.
Diseases | Clinical manifestations | Para-clinical findings | Gold standard | Additional findings | ||||||||||||||
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Symptoms | Physical examination | |||||||||||||||||
Lab Findings | Imaging | Histopathology | ||||||||||||||||
Dyspnea | Fever | Weight loss | Arthralgia | Skin manifestation | Organomegaly | Focal neurological disorder | CBC | ESR | Antibodies | Other | CT scan | Other | ||||||
Antiphospholipid syndrome | + | + | - | - | Livedo reticularis, palpable purpura, leg ulcers, raynaud phenomena | hepatomegaly, | Stroke, transient ischemic attack | Schistocytes on peripheral smear,Thrombocytopenia, Hemolytic anemia | ↑ | Lupus anticoagulant,anticardiolipin antibodies | - | Stroke, | Doppler ultrasonography for recurrent DVT | Noninflammatory bland thrombosis without perivascular inflammation | Hx of thrombosis and antiphospholipid antibodies | Miscarriage, Pulmonary hypertension | ||
Systemic lupus erythematosus (SLE) | + | Leukopenia, Lymphopenia, Anemia, Thrombocytopenia | ↑ | Anti dsDNA, ANA | ↑Cr or BUN,
↑ALT or AST, Proteinuria |
Interstitial lung disease, Pneumonitis, Pulmonary emboli, Alveolar hemorrhage | Central nervous system (CNS) lupuswhite-matter changes in MRI | Staging lupus nephritis | Anti-dsDNA antibody test | Skin rashes or photosensitivity | ||||||||
Thrombosis | Thrombophilia | DIC | + | + | - | +/- | Acral cyanosis, Hemorrhagic skin infarctions | - | + | Thrombocytopenia, Schistocytes | ↑ | - | ↑D-dimer, aPTT and PT | Intracranial hemorrhage | - | Ischemia and necrosis due to fibrin deposition in small and medium-sized vessels | Clinical findings coupled with laboratory abnormalities | - |
HUS | + | + | - | + | Liver/spleen swelling | + | Anemia, | ↑ | ADAMTS13 | Increased lactate dehydrogenase | Thalami, brainstem, or cerebellumabnormality | Microthrombosesinclude fibrin thrombi that may occlude the glomerular tufts | Clinical findings coupled with laboratory abnormalities | Hematuria, Proteinuria | ||||
ITP | +/- | - | + | Petechiae | Splenomegaly | + | Anemia, Thrombocytopenia | - | Anti platelet factor 4 antibodies | HIV, ANA | R/O other causes | - | Increased number of normal morphologic megakaryocytes | Clinical findings coupled with thrombocytopenia | Easy bruising, Purpura | |||
HELLP | - | - | - | - | Hepatomegaly | + | Anemia, Thrombocytopenia, Schistocytes | - | - | ↑Bilirubin, ↓Haptoglobin, ↑LDH, ↑Cr | Cortical hypodense areas in the occipital lobes, Diffuse cerebral edema | Ultrasonography shows Poor fetal growth, Oligohydramnios, Abnormal umbilical artery | - | 24-hour urine study | Seizure, Edema | |||
Paroxysmal nocturnal hemoglobinuria (PNH) | + | + | - | +/- | Anemia, reticulocytosis,
Increased lactate dehydrogenase (LDH) and bilirubin |
- | Direct antiglobulin (Coombs) testing (DAT) | Increased haptoglobin | - | - | Bone marrow biopsy shows normocellular or hypercellular bone marrow with erythroid hyperplasia | Flow cytometry | ||||||
Heparin-induced thrombocytopenia (HIT) | + | + | - | - |
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- | + | Thrombocytopenia | + | Anti-heparin-PF4 IgG |
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Stroke, pulmonary embolism, mesenteric ischemia, intraabdominal or retroperitoneal bleeding, or acute limb ischemia. | - | Schistocytes | Serotonin release assay | Limb gangrene
Skin necrosis | ||
Myeloproliferative diseases | + | + | + | + |
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Splenomegaly | - | ↑WBCs, predominantly neutrophils | + | - |
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PET scan- metastasis in bone marrow | Terminal myeloid cell expansion | Philedelphia chromosome by PCR or BCR/ABL by FISH | ||||
Recurrent pregnancy loss | Uterine abnormality | - | - | - | - | - | - | - | - | - | - | - | - | - | - | Ultrasound | - | |
Chromosomal abnormality | - | -/+ | - | - | - | - | - | - | - | - | - | - | - | - | Karyotyping | - | ||
Hypothyroidism | - | -/+ | - | - | Myxedema
Dry skin |
- | - | - | + | - | - | - |
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