Welcoming @SarahGoglinMD via @UCSFRheum for our grand rounds today!
Time to learn about #APS
When to consider seronegative APS?
👉recurrent episodes of thrombosis, especially arterial or unusual venous sites, without identifiable RFs for thrombosis
There is not one accepted set of criteria for seronegative APS
Note: In almost all cases, the presence of non-criteria manifestations
What are non-criteria manifestations of APS?
🔹Phosphatidylserine autoAbs -- will likely be included in the revision of the APS criteria
🔹Not all Abs to beta2-GPI are created equally; some are not clinically significant (binding to domain 1 with highest risk of thrombosis)
Paper of note: pubmed.ncbi.nlm.nih.gov/32085759/
Quick review of prolonged PTT in lupus pts
👉First, consider the presence of an inhibitor vs factor deficiency
👉Then, consider inhibitors besides lupus anticoagulants
3 steps to 1⃣screen 2⃣mix 3⃣ confirm the presence of lupus anticoagulant
Why is this important? Pts with lupus may develop acquired factor inhibitors (most commonly factor VIII) that can cause spontaneous & catastrophic bleeding 🩸
APS nephropathy: a spectrum of intra-renal pathology from acute thrombosis and TMA to chronic vascular lesions with fibrosis intimal hyperplasia
Excellent review here: pubmed.ncbi.nlm.nih.gov/24642799/
🤔What is the role of anticoagulation for pts with lupus nephritis who are aPL+ with evidence of thrombosis on renal biopsy?
Multicenter study 🇮🇹🇺🇸: pubmed.ncbi.nlm.nih.gov/30552172/
What about APS & membranous nephropathy?
🧪Anti-beta2-GPI Ab may play a role in progression of membranous nephropathy -- further work to be done in this area
🩺Limited data to guide mgmt!
Caution to be taken around the renal biopsy in patients on anticoagulation for APS! 🛑
🦠COVID-19 & aPLs
from @APS_ACTION:
pubmed.ncbi.nlm.nih.gov/34915764/
aPLs in COVID-19:
❓Pathogenic? Evidence supporting this in 🐭and observational data from 🏥
❓Epiphenomena? Evidence supporting this in studies showing transience of these autoAbs
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