iatroX Rounds #36
The clues
- 1
A 32-year-old woman presents with pain and swelling in her left calf following a short domestic flight.
- 2
This is her second episode of venous thromboembolism in three years, despite having no significant surgical history or recent immobilisation.
- 3
She has a history of three consecutive spontaneous miscarriages, all occurring before the 10th week of gestation.
- 4
On examination, her skin shows a mottled, purple, lace-like reticular pattern across her thighs and forearms.
- 5
Initial bloods show a mildly prolonged activated partial thromboplastin time (aPTT) that does not correct when mixed with normal plasma.
- 6
Testing reveals persistent positivity for lupus anticoagulant, anti-cardiolipin antibodies, and anti-beta-2 glycoprotein I antibodies on two occasions twelve weeks apart.
Antiphospholipid syndrome is an autoimmune prothrombotic condition characterized by venous or arterial thrombosis and pregnancy complications. It is defined by the persistent presence of specific antibodies that interfere with the coagulation cascade.
- Recurrent venous and arterial thrombosis
- Adverse pregnancy outcomes including recurrent miscarriage and pre-eclampsia
- Livedo reticularis and thrombocytopenia
- Paradoxical prolongation of the aPTT
for education and entertainment. not medical advice.