Keywords by Inquiry, Referral and Journal writing by APLS 4.5/5 (2)

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Importantly

Suspected ApL diagnosis

  • Disease history (thromboembolism, spontaneous abortion)
  • Results of medical examinations (see below)
  • Antibodies (ANA, anti-cardiolipin and / or beta2 glycoprotein) and / or lupus anticoagulant (coagulation laboratory)

Disease history

Medical examinations

  • Clinical investigation findings
    • Signs of SLE or other rheumatic disease?
    • Arthritis, skin, blood (low blood cell count), kidneys (edema, urine test), heart, lungs, ANA and other antibodies
    •  Skin symptoms
  • Serum Antibodies
    • ANA (possibly subgroups), Cardiolipin antibody, Beta-2 glycoprotein antibody, Lupus anticoagulant (Coagulation laboratory)

 

Differential diagnoses for CAPS (Kazzaz, NM, 2016)
  CAPS TTP HOUSE DIC HELLP SRC HIT
Microvascular thrombosis + + + + + -
Macrovascular thrombosis + - - + - +
Bleeding - - + +/- - -
Multiorganic failure ++ +/- +/- +/- - -
Kidney failure +/- ++ - +/- ++ -
Mentally reduced +/- +/- - +/- - -
Lung Disease (ARDS) ++ / - - +/- +/- - -
Heart disease (Infarction, failure) +/- - - - - -
Pregnancy +/- - +/- + - -
Infection +/- +/- +/- - - -
Malignancy +/- - +/- - - -
Hemolytic anemia +/- ++ +/- + + -
Schistocytter +/- ++ +/- + + -
Thrombocytopenia +/- ++ + + +/- ++
Extended PTT +/- - + - - -
Fibrinogen Normal Normal Normal Normal Normal
Liver enzymes Normal Normal ↑↑ Normal Normal
APL (> 40 U / ml) ++ - - - - -
ADAMTS13 Normal Normal Normal Normal
Anti-PF4 - - - - - ++

Referral to specialist

  • Rheumatologist referral is relevant if rheumatic symptoms are present or for "secondary antiphospholipid syndrome" related to SLE or (rarer) other rheumatic disease
  • Hematologist referral if a primarily APLS is suspected
  • Maternity outpatient clinic / gynecologist is contacted if planned or present pregnancy

Norwegian Directorate of Health (Supervisor for referrals)

Antifosfolipid syndrome BINDVEVESSYKDOMMER.no


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