IBCC Episode 91 - Catastrophic Antiphospholipid Syndrome

The Internet Book of Critical Care Podcast

Adam Thomas

Foam, Medicine, Health & Fitness, Science, Criticalcare, Medicaleducation

5 • 714 Ratings

🗓️ 22 July 2020

⏱️ 20 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this episode we cover Catastrophic Antiphospholipid Syndrome. A very rare and often missed diagnosis. Come take a listen to brush up on high risk patient population, clinical diagnosis, labs, steroids / anticoagulation and more treatment options.

Transcript

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0:00.0	All right, so welcome back to the Internet Book of Critical Care podcast.
0:08.4	I'm here with Adam Thomas, and we're going to talk about catastrophic antifospholipid
0:12.1	Antipody Syndrome today, or Caps.
0:14.0	We're moving away from the less boring things, and now you can't make it into the IBCC
0:17.9	without some horrible language in the name, right?
0:22.1	It's catastrophic. You're running into trouble. So today, let's get straight into it. Pathophysiology. What is antifosphylipit
0:27.6	antibody syndrome? And you snuck it in because a lot of people are talking about it with COVID.
0:31.7	Yeah. So antifosophilipid antibody syndrome is one of the more confusing entities in hematology.
0:36.6	Honestly, it's caused by a variety
0:37.9	of different antibodies that bind to cell surfaces and essentially trigger hypercoaculability.
0:43.0	In vitro, some of these antibodies can increase the PTT. The so-called lupus anticoagulant effect,
0:48.3	but in vivo, they cause coagulation. And honestly, this is confusing because different patients
0:52.2	can have different antibodies and they may behave in slightly different ways.
0:55.6	But I think this is really interesting because it's clearly in favor that we're thinking about the interactions between immune-mediated thrombophilia or thrombosis more and more.
1:03.9	And this is pertinent both in what's going on in the world, but also in our super sick patients, because you'll talk about it in epidemiology, but a lot of patients present
1:11.2	with this as their primary presentation. Yeah. And honestly, I think that's going to be the
1:14.8	major challenge here, which is diagnosing this, which is not easy for patients. You do not have a
1:19.5	history of antifosphalipid antibody syndrome or lupus. So let's set the groundwork because it's
1:23.8	really important that we get the basics. You kind of alluded to this. But talk to me about the pathophysiology that you've outlined here in a figure between our trigger and its
1:31.5	interplay between the antifosphalipid antibodies, the several that are out there, the complement system,
1:36.7	the microvascular vessels themselves, and then how tissues become eschemic and kind of run away
1:42.9	with positive feedback into this.
	...

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