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Rheumatology

Question
11 out of 37
 

Autoimmune destruction of platelet is seen in :(AIIMS May 95)



A SLE
B Rheumatoid arthritis

C Reiter disease
D Polyarteritisnodosa

Ans. A SLE

Antiphospholipid antibody syndrome

i. This syndrome occurs in 5% of the general population, but is associated with 50% cases of SLE.

ii. Patients have anti phospholipid antibodies such as lupus anticoagulant, anticardiolipin antibody or anti beta 2 glycoprotein (AIPG 2011) (Harrison-18th, edition Pg- 2736)

iii. Because phospholipids are integral parts of the control of coagulation, these antibodies can lead to a hypercoagulable state, i.e., anti phospholipid antibody syndrome.

Patients with antiphospholipid antibody syndrome fall into two categories.

1. Primary antiphospholipid antibody syndrome

· In these cases there is no evidence of other autoimmune disease, the patient exhibit only the manifestations of antiphospholipid antibody syndrome.

2. Secondary antiphospholipid antibody syndrome

· In this cases antiphospholipid antibody syndrome is associated with an autoimmune disease usually SLE.

Clinical manifestations of antiphospholipid antibody syndrome:

i. Asymptomatic.

ii. Arterial and venous thromboembolism, avascular osteonecrosis.

iii) Hematologic

· Cytopenia: Thrombocytopenia, autoimmune hemolytic anemia, leukopenia. Pancytopenia can occur. (AIIMS May 2011)

§ Coagulopathy: Platelet dysfunction, prothrombin deficiency.

§ Neurologic

§ Acute ischemia (CVA, TIA, encephalopathy);

§ Dermatologic

§ Livedoreticularis, acrocyanosis, wide spread cutaneous necro­sis,

§ Cardiopulmonary

§ Marantic endocarditis, myocardial infarction, peripheral arterial disease. pulmonary hypertension.

§ Obstetric

§ Recurrent spontaneous abortion predominantly second trimester, IUGR, preeclampsia,

viii. Catastrophic antiphospholipid syndromes

Important Points::

In lupus anticoagulant thrombosis occurs (there is no increase in thrombocytes).

Coagulation tests in lupus anticoagulant

PTT → Prolonged

PT → Normal

Fibrinogen → Normal

Important Points:

a. Antiphospholipid antibodies bind to cardiolipin antigen, used in serologic tests for syphilis, and therefore lupus patients may have a false-positive test result for syphilis.

b. Thrombocytopenia occurs.

c. Sterility is not a feature

Rheumatology Flashcard List

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