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Spring J, Munshi L. Hematology Emergencies in Critically Ill Adults. Chest 2022; 161:1285-1296. [DOI: 10.1016/j.chest.2021.12.650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/14/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022] Open
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Liu LW, Tsai HH, Lafian A, Sadeghi-Najafabadi E. A Case of Probable Catastrophic Antiphospholipid Syndrome Treated With Rituximab and Without Anticoagulation. J Clin Rheumatol 2021; 27:S541-S542. [PMID: 31124923 DOI: 10.1097/rhu.0000000000001078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rodríguez-Pintó I, Lozano M, Cid J, Espinosa G, Cervera R. Plasma exchange in catastrophic antiphospholipid syndrome. Presse Med 2019; 48:347-353. [PMID: 31694791 DOI: 10.1016/j.lpm.2019.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Plasma exchange is a well-established therapeutic procedure commonly used in many autoimmune disorders. The beneficial effects of plasma exchange are thought to occur through the elimination of pathogenic mediators found in plasma, including autoantibodies, complement components, and cytokines. The catastrophic antiphsopholipid syndrome (CAPS) is a life-threatening variant of the antiphospholipid syndrome (APS) where several thrombosis take place in a short period of time in patients with circulating antiphospholipid antibodies. The triple therapy with anticoagulation, corticosteroids and plasma exchange or intravenous immunoglobulins has been proposed in CAPS. CAPS is a rare disease precluding the conduction of formal clinical trials. However, the observation of a better clinical course of patients who received this treatment supports their use. Plasma exchange has become an established therapeutic procedure in CAPS but there are no studies regarding the better approach and thus its use relies on the experience of the physicians in charge. The current article aims to review potential mechanisms of action of plasma exchange and the technical aspects of this procedure and will focus on its current role in CAPS, the experience published in treating this condition and the treatment protocol that we use in our institution.
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Affiliation(s)
- Ignasi Rodríguez-Pintó
- Hospital Universitari Mutua de Terrassa, Systemic Autoimmune Disease Unit, Barcelona, Catalonia, Spain
| | - Miquel Lozano
- Hospital Clínic, Department of Haemotherapy and Hemostasis, Barcelona, Catalonia, Spain
| | - Joan Cid
- Hospital Clínic, Department of Haemotherapy and Hemostasis, Barcelona, Catalonia, Spain
| | - Gerard Espinosa
- Hospital Clínic, Department of Autoimmune Diseases, Barcelona, Catalonia, Spain
| | - Ricard Cervera
- Hospital Clínic, Department of Autoimmune Diseases, Barcelona, Catalonia, Spain.
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Plummer MP, Young AMH, O'Leary R, Damian MS, Lavinio A. Probable Catastrophic Antiphospholipid Syndrome with Intracerebral Hemorrhage Secondary to Epstein-Barr Viral Infection. Neurocrit Care 2019; 28:127-132. [PMID: 28357636 DOI: 10.1007/s12028-017-0392-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Catastrophic antiphospholipid syndrome (CAPS) is a rare, severe variant of antiphospholipid syndrome with a high mortality rate. We report a unique case of CAPS secondary to Epstein-Barr viral (EBV) infection complicated by pulmonary and intracerebral hemorrhage. A review of the CAPS literature relevant to intensive care practice is used to outline a rational approach to diagnosis and management. METHODS All data are from a single patient admitted to the Neurosciences Critical Care Unit in Addenbrooke's Hospital, Cambridge, in March 2016. Medline, Web of Science, PubMed, and the Cochrane Library were searched through September 2016 without restrictions for cases of CAPS, management of CAPS in the intensive care unit, and hemorrhage complicating CAPS. The patient gave express written consent to access and publish these data. RESULTS This is only the second reported case of probable CAPS secondary to EBV infection. Furthermore, pulmonary and intracerebral hemorrhage is rare manifestations of this multisystem prothrombotic state which provided unique challenges to the management. CONCLUSIONS While rare, CAPS should be considered in any patient presenting with rapidly progressive multiorgan failure, evidence of thrombotic microangiopathy, and antiphospholipid antibodies. A high index of suspicion is required as early, aggressive, multimodal treatment with anticoagulation, and immunosuppression improves outcomes.
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Affiliation(s)
- Mark P Plummer
- Neurosciences and Trauma Critical Care Unit, Addenbrooke's Hospital, Cambridge, University Hospitals, Cambridge, CB2 0QQ, UK.
| | - Adam M H Young
- Neurosciences and Trauma Critical Care Unit, Addenbrooke's Hospital, Cambridge, University Hospitals, Cambridge, CB2 0QQ, UK
| | - Ronan O'Leary
- Neurosciences and Trauma Critical Care Unit, Addenbrooke's Hospital, Cambridge, University Hospitals, Cambridge, CB2 0QQ, UK
| | - Maxwell S Damian
- Neurosciences and Trauma Critical Care Unit, Addenbrooke's Hospital, Cambridge, University Hospitals, Cambridge, CB2 0QQ, UK
| | - Andrea Lavinio
- Neurosciences and Trauma Critical Care Unit, Addenbrooke's Hospital, Cambridge, University Hospitals, Cambridge, CB2 0QQ, UK
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5
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The diagnosis and clinical management of the catastrophic antiphospholipid syndrome: A comprehensive review. J Autoimmun 2018; 92:1-11. [DOI: 10.1016/j.jaut.2018.05.007] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/10/2018] [Indexed: 01/13/2023]
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6
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Rumsey DG, Myones B, Massicotte P. Diagnosis and treatment of antiphospholipid syndrome in childhood: A review. Blood Cells Mol Dis 2017; 67:34-40. [PMID: 28283251 DOI: 10.1016/j.bcmd.2017.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/23/2017] [Accepted: 02/26/2017] [Indexed: 01/14/2023]
Abstract
The antiphospholipid syndrome (APS) is a multisystem autoimmune disease characterized by recurrent fetal loss and thromboembolic events associated with the presence of elevated titres of antiphospholipid antibodies (aPL). The purpose of this review is to summarize what is currently known about the diagnosis and treatment of pediatric APS, to highlight key differences between APS presenting in adults versus children throughout, and to identify areas where future research is needed.
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Affiliation(s)
- Dax G Rumsey
- Department of Pediatrics, University of Alberta, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada.
| | - Barry Myones
- Pediatric Rheumatology, 2119 Plantation Bend Drive, Sugar Land, TX 77478, USA
| | - Patti Massicotte
- Department of Pediatrics, University of Alberta, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada
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7
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Treatment of Catastrophic Antiphospholipid Syndrome. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/b978-0-444-63655-3.00017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Abstract
PURPOSE OF REVIEW Catastrophic antiphospholipid syndrome (CAPS) is a severe manifestation of antiphospholipid syndrome (APS). Although affecting only 1% of patients with APS, the condition is frequently fatal if not recognized and treated early. Here, we will review the current approach to diagnosis and treatment of CAPS. RECENT FINDINGS Data from the international 'CAPS registry', spearheaded by the European Forum on Antiphospholipid Antibodies, have improved our understanding of at-risk patients, typical clinical features, and precipitating diagnoses. Current guidelines also continue to support the role of anticoagulants and glucocorticoids as foundation therapy in all patients. Finally, new basic science and case series suggest that novel therapies, such as rituximab and eculizumab, warrant further study. SUMMARY Attention to associated diagnoses, such as infection and systemic lupus erythematosus (SLE), is critical at the time of diagnosis. All patients should be treated with anticoagulants, corticosteroids, and possibly plasma exchange. In patients with SLE, cyclophosphamide should be considered. In refractory or relapsing cases, new therapies, such as rituximab and possibly eculizumab, may be options, but need further study.
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9
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Rodriguez-Pintó I, Espinosa G, Cervera R. Catastrophic antiphospholipid syndrome: The current management approach. Best Pract Res Clin Rheumatol 2016; 30:239-249. [DOI: 10.1016/j.berh.2016.07.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 02/08/2023]
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Abstract
Antiphospholipid syndrome (APS) is a multisystem autoimmune condition characterized by vascular thromboses associated with persistently positive antiphospholipid antibodies. There is currently a paucity of data (incidence, prevalence, thrombosis risk, and effective treatment) in pediatric APS. The purpose of this report is to review the current literature on APS in children and neonates, identify the gaps in current knowledge, and suggest avenues for studies to fill those gaps.
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11
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The. ANTIPHOSPHOLIPID ANTIBODY SYNDROME 2015. [PMCID: PMC7153043 DOI: 10.1007/978-3-319-11044-8_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The addition of the word “catastrophic” to the term antiphospholipid syndrome (APS) was proposed 20 years ago by Ronald Asherson when he published an editorial in The Journal of Rheumatology describing a group of patients who develop multiple thrombosis in a short period of time and with a much worse prognosis than that attributed to patients with classic APS [1]. Since then, many cases have been published reporting patients with this devastating variant of the APS.
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Aguiar CL, Erkan D. Catastrophic antiphospholipid syndrome: how to diagnose a rare but highly fatal disease. Ther Adv Musculoskelet Dis 2013; 5:305-14. [PMID: 24294304 DOI: 10.1177/1759720x13502919] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Antiphospholipid syndrome (APS) is a multisystem autoimmune condition characterized by vascular thromboses and/or pregnancy loss associated with persistently positive antiphospholipid antibodies (aPL). Catastrophic APS (CAPS) is the most severe form of APS with multiple organ involvement developing over a short period of time, usually associated with microthrombosis. 'Definite' and 'probable' CAPS have been defined based on the preliminary classification criteria; however, in a real-world setting, aPL-positive patients with multiple organ thromboses and/or thrombotic microangiopathies exist who do not fulfill these criteria. Previous APS diagnosis and/or persistent clinically significant aPL positivity is of great importance for the CAPS diagnosis; however, almost half of the patients who develop CAPS do not have a history of aPL positivity. The purpose of this paper is to summarize the diagnostic challenges and the recently updated diagnostic algorithms for CAPS providing a 'step-by-step' approach for clinicians (and researchers) in the assessment of patients with multiple organ thromboses.
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Affiliation(s)
- Cassyanne L Aguiar
- Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA
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Park HC, Yoon HB, Lee TW, Jung JY, Chin HJ, Kim YS, Kim S. Recurrent thrombotic events after catastrophic antiphopholipid syndrome. Korean J Intern Med 2012; 27:232-4. [PMID: 22707899 PMCID: PMC3372811 DOI: 10.3904/kjim.2012.27.2.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 01/09/2009] [Accepted: 03/12/2009] [Indexed: 11/27/2022] Open
Affiliation(s)
- Hayne Cho Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Bae Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Tae Woo Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ji Yong Jung
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ho Jun Chin
- Renal Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Renal Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Suhnggwon Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Renal Research Institute, Seoul National University College of Medicine, Seoul, Korea
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15
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Francès C, Barete S, Soria A. Manifestations dermatologiques du syndrome des antiphospholipides. Rev Med Interne 2012; 33:200-5. [DOI: 10.1016/j.revmed.2011.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Accepted: 10/06/2011] [Indexed: 12/14/2022]
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Therapeutic plasma exchange for the management of refractory systemic autoimmune diseases: Report of 31 cases and review of the literature. Autoimmun Rev 2011; 10:679-84. [DOI: 10.1016/j.autrev.2011.04.028] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Abstract
Pulmonary vasculitis can occur in apparent isolation, as part of a primary systemic vasculitis, or with an underlying systemic inflammatory autoimmune disorder. The presentation of pulmonary vasculitis in the intensive care unit (ICU) can be fulminant and will often overlap with more common disorders that affect the critically ill. Although diffuse alveolar hemorrhage (DAH) is the clinical feature that often initiates the concern for an underlying vasculitis, hemoptysis may not be apparent or its presentation can be mistaken for an alternative disease process. As a result, the diagnosis of pulmonary vasculitis in the ICU may be delayed or be completely unrecognized. A high level of suspicion is essential to obtain a timely diagnosis and for effective therapies to be implemented. There have been significant advances this past decade in diagnostic strategies as well as in the therapeutic options for patients with pulmonary vasculitis. We review here the clinical presentations, diagnostic strategies, and treatment options of the critically ill patients presenting with pulmonary vasculitis. The reader is referred to other resources for a more comprehensive review of specific vasculitic entities.
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Affiliation(s)
- Jesus Diaz
- Department of Internal Medicine, Division of Pulmonary Medicine, Mayo Clinic, Jacksonville, FL, USA
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Zandman-Goddard G, Krauthammer A, Levy Y, Langevitz P, Shoenfeld Y. Long-Term Therapy with Intravenous Immunoglobulin is Beneficial in Patients with Autoimmune Diseases. Clin Rev Allergy Immunol 2011; 42:247-55. [DOI: 10.1007/s12016-011-8278-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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19
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Espinosa G, Cervera R. Current management of catastrophic antiphospholipid syndrome. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ijr.11.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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20
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Josse S, Benhamou Y, Girault C, Lecam-Duchez V, Provost D, Verspyck E, Piquenot JM, Lévesque H, Queyrel V. Plaquettes-blues du post-partum. Rev Med Interne 2011; 32:255-60. [DOI: 10.1016/j.revmed.2010.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 12/22/2010] [Indexed: 10/18/2022]
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21
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Benefits and limitations of plasmapheresis in renal diseases: an evidence-based approach. J Artif Organs 2010; 14:9-22. [DOI: 10.1007/s10047-010-0529-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 11/08/2010] [Indexed: 01/26/2023]
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Erkan D, Espinosa G, Cervera R. Catastrophic antiphospholipid syndrome: updated diagnostic algorithms. Autoimmun Rev 2010; 10:74-9. [PMID: 20696282 DOI: 10.1016/j.autrev.2010.08.005] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 08/03/2010] [Indexed: 11/30/2022]
Abstract
The catastrophic antiphospholipid syndrome (APS) is the most severe form of APS with acute multiple organ involvement and small vessel thrombosis. During the 13th International Congress on Antiphospholipid Antibodies (aPL) a "Catastrophic APS Task Force" was developed to discuss the challenges in the diagnosis and management of catastrophic APS. The purpose of this paper is to summarize the diagnostic challenges (false-positive/negative aPL results and overlap with other thrombotic microangiopathies) and propose updated diagnostic algorithms for catastrophic APS. Important steps of the diagnostic algorithms include: a) history of APS or persistent aPL-positivity; b) three or more organ new thrombosis developing in less than a week; c) biopsy diagnosis of microthrombosis; and d) other explanations for multiple organ thromboses and/or microthrombosis.
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Affiliation(s)
- Doruk Erkan
- The Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA
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23
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Abstract
The dermatological manifestations of antiphospholipid syndrome (APS) may be the presenting features of APS syndrome. They are extremely diverse and heterogeneous, ranging from minor signs to life-threatening conditions such as widespread cutaneous necrosis. Their clinical significance is highly variable. Livedo reticularis is strongly associated with the arterial and microangiopathic subtypes of APS. Scientific data are required to determine the optimum management of these patients, who might benefit from recently developed antithrombotic agents. Lupus (2010) 19, 1071—1077.
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Affiliation(s)
- C. Frances
- Department of Dermatology-Allergology, Hôpital Tenon, Paris, France,
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Owaidah TM, Maghrabi K, Elkarouri MA, Al Mohareeb F, Al Harthi A, Al Zahrani H. Successful treatment of a case of catastrophic antiphospholipid syndrome with autologous BMT: case report and review of literature. Bone Marrow Transplant 2010; 46:597-600. [PMID: 20661234 DOI: 10.1038/bmt.2010.148] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- T M Owaidah
- Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
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Vibert J, Gelsi E, Vanbiervliet G, Dellamonica J, Tieulie N, Dahman M, Hastier P, Bernardin G, Tran A, Hebuterne X. [Severe acute pancreatitis revealing an antiphospholipid syndrome]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2010; 34:233-236. [PMID: 20219307 DOI: 10.1016/j.gcb.2009.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Revised: 10/31/2009] [Accepted: 11/27/2009] [Indexed: 05/28/2023]
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27
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Erkan D, Lockshin MD. New approaches for managing antiphospholipid syndrome. Nat Rev Rheumatol 2009; 5:160-70. [DOI: 10.1038/ncprheum1017] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Accepted: 12/17/2008] [Indexed: 11/09/2022]
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Kim S, Moskowitz NK, DiCarlo EF, Bass AR, Erkan D, Lockshin MD. Catastrophic antiphospholipid syndrome triggered by sepsis. HSS J 2009; 5:67-72. [PMID: 19096893 PMCID: PMC2642545 DOI: 10.1007/s11420-008-9103-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 11/05/2008] [Indexed: 02/07/2023]
Affiliation(s)
- Susan Kim
- Department of Medicine, Weill-Cornell New York Presbyterian Hospital, 546 East 68th Street, New York, NY 10021, USA.
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Bortolati M, Marson P, Fabris F, Pengo V, Facchinetti M, De Silvestro G, Ruffatti A. Recovery from catastrophic antiphospholipid syndrome by a plasma exchange procedure: report of four cases and review of the literature. Autoimmun Rev 2009; 8:297-301. [DOI: 10.1016/j.autrev.2008.09.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Accepted: 09/03/2008] [Indexed: 11/17/2022]
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Abstract
Antiphospholipid syndrome is diagnosed when arterial or venous thrombosis or recurrent miscarriages occur in a person in whom laboratory tests for antiphospholipid antibodies (anticardiolipin antibodies and/or lupus anticoagulant and/or anti-beta 2-glycoprotein I) are positive. Despite the strong association between antiphospho-lipid antibodies and thrombosis, their pathogenic role in the development of thrombosis has not been fully elucidated. Novel mechanisms involving both the complement pathway and micro-particles have been described. The knowledge of these new pathogenic approaches might identify novel therapeutic targets and therefore may improve the management of these patients.
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Affiliation(s)
- Gerard Espinosa
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, Catalonia, Spain.
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31
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The Catastrophic Antiphospholipid Syndrome in Serbia: Diagnostic and Management Problems. Clin Rev Allergy Immunol 2008; 36:98-103. [DOI: 10.1007/s12016-008-8102-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Pers YM, Puygrenier M, Borlot F, Simorre B, Barazer I, Oziol E, Reny JL. [Acute Q fever, antiphopholipid antibodies and renal artery thrombosis: case report and literature review]. Rev Med Interne 2008; 30:250-4. [PMID: 19026472 DOI: 10.1016/j.revmed.2008.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 08/29/2008] [Accepted: 10/08/2008] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Antiphospholipid antibodies (aPL) can be associated with numerous infectious and particularly Q fever. Data on the pathogenicity of aPL in the course of acute Q fever are scarce. CASE REPORT We report the case an acute Coxiella burnetii infection associated with clinical and biological manifestations of the aPL syndrome, including a renal infarction. Along with antibiotic treatment, anticoagulation and intravenous immunoglobulins, the clinical outcome was favourable. Antiphospholipid antibodies and Q fever antibody titers had a closely related evolution. CONCLUSION Arterial thrombosis associated with Q fever and aPL is exceptional. The nosology and potential mechanisms are discussed.
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Affiliation(s)
- Y-M Pers
- Département de médecine interne, Centre hospitalier de Béziers, 34525 Béziers cedex, France
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Marson P, Bagatella P, Bortolati M, Tison T, De Silvestro G, Fabris F, Pengo V, Ruffatti A. Plasma exchange for the management of the catastrophic antiphospholipid syndrome: importance of the type of fluid replacement. J Intern Med 2008; 264:201-3. [PMID: 18341530 DOI: 10.1111/j.1365-2796.2008.01942.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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34
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Haddad F, Jammal M, Maalouly G, Nemnoum R, Irani C, Tohme A. Syndrome catastrophique des antiphospholipides : un nouveau cas. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.03.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Baker WF, Bick RL, Fareed J. Controversies and unresolved issues in antiphospholipid syndrome pathogenesis and management. Hematol Oncol Clin North Am 2008; 22:155-74, viii. [PMID: 18207073 DOI: 10.1016/j.hoc.2007.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
While much is understood concerning the clinical features of patients with antiphospholipid syndrome (APS), many issues remain. The proper designation of patients with "definite" APS and the correct categorization of patients by both laboratory and clinical features are matters of ongoing debate. Recent proposals have identified new subsets of patients who have many typical features of APS but either do not fit the criteria for a "definite" diagnosis or have initially negative laboratory tests for antiphospholipid antibodies. Meanwhile, decisions about laboratory tests are based on expert opinion, rather than the results of controlled trials. As for treatment, many guidelines are offered, but few are backed by data from strong clinical trials. This article summarizes the clinical questions remaining to be answered and debates concerning pathogenesis, diagnosis, and management.
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Affiliation(s)
- William F Baker
- David Geffen School of Medicine, Center for Health Sciences, University of California, Los Angeles, Los Angeles, CA, USA.
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Antiphospholipid Syndrome: Role of Antiphospholipid Antibodies in Neurology. Hematol Oncol Clin North Am 2008; 22:95-105, vii. [DOI: 10.1016/j.hoc.2007.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Antiphospholipid syndrome (APS) is primarily considered to be an autoimmune pathological condition that is also referred to as "Hughes syndrome". It is characterized by arterial and/or venous thrombosis and pregnancy pathologies in the presence of anticardiolipin antibodies and/or lupus anticoagulant. APS can occur either as a primary disease or secondary to a connective tissue disorder, most frequently systemic lupus erythematosus (SLE). Damage to the nervous system is one of the most prominent clinical constellations of sequelae in APS and includes (i) arterial/ venous thrombotic events, (ii) psychiatric features and (iii) other non- thrombotic neurological syndromes. In this overview we compare the most important vascular ischemic (occlusive) disturbances (VIOD) with neuro-psychiatric symptomatics, together with complete, updated classifications and hypotheses for the etio-pathogenesis of APS with underlying clinical and laboratory criteria for optimal diagnosis and disease management.
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Affiliation(s)
- Penka A Atanassova
- Department of Neurology, Medical University, 15A V. Aprilov Blvd., Plovdiv, 4000, Bulgaria.
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