| Identifier |
anti_phospholipid_antibody_syndrome_lee |
| Title |
Anti Phospholipid Antibody Syndrome |
| Creator |
Andrew G. Lee, MD; Christine Tang |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (CT) Class of 2023, Baylor College of Medicine, Houston, Texas |
| Subject |
Antiphospholipid Antibody Syndrome; Pulmonary Embolism; CRAO; BRAO; CRVO; BRVO; Thrombotic Events |
| Description |
Summary: • Antiphospholipid antibodies can cause recurrent thrombotic events: o Pulmonary embolism, deep venous thrombosis o Central retinal artery occlusion (CRAO)/branch retinal artery occlusion (BRAO) o Central retinal vein occlusion (CRVO)/branch retinal vein occlusion (BRVO) o Ischemic optic neuropathy - anterior/posterior o Intracranial strokes • Supratentorial -> homonymous hemianopsia, cortical visual impairment • Infratentorial in brainstem -> diplopia, nystagmus • Antiphospholipid antibody orders in patient with unexplained stroke and/or underlying collagen vascular disorder: o Russell venom viper time • Causes clots. Serial dilutions -> measure amount of time blood clots • If have anticoagulant in blood, can be utilized as a functional assay to tell that there is an anticoagulant causing prolonged clotting time o PT/PTT o Lupus anticoagulant cardiolipin antibodies • Patient does not need to have lupus. Patient can have any collagen vascular disorder. • Only an anticoagulant in vitro. It is a procoagulant in vivo. o Glycoprotein IIb • Glycoprotein is the binding site on the endothelium of blood vessels. • Antibody interacts with glycoprotein -> fibrin will make thrombus. • Females have additional criteria for being tested for antiphospholipid antibody syndrome o Spontaneous miscarriage • Before 10 weeks, allowed up to 3 miscarriages before testing • After 10 weeks, will ask about eclampsia/preeclampsia and placental insufficiency. Should consider antiphospholipid antibody syndrome • Livedo reticularis - another symptom that is present in a lot of patients with antiphospholipid antibodies o Rash on skin that is reticulated and purple o Especially prominent in lower extremities. |
| Transcript |
Today we're going to be talking about anti phospholipid antibodies in neuro-ophthalmology, and the phospholipid is the part of the bilayer and so it's in membranes. And so when you get antibody against the phospholipid component it's going to cause problems, and the problems that we are going to be seeing as ophthalmologists are recurrent thrombotic events, either arterial or venous. So where the venous side that's pulmonary embolus or deep venous thrombosis, or the ophthalmology side that's going to be central retinal artery occlusion or branch retinal artery, or central retinal vein occlusion or branch retinal vein occlusions. Ischemic optic neuropathy, either anterior or posterior. And intracranial strokes, those can be supratentorial, causing homonymous hemianopsia, cortical visual impairment, or infratentorial in the brainstem, causing diplopia and nystagmus.; So when you have unexplained stroke, especially in a young person or someone who has an underlying collagen vascular disorder, you should be thinking about antiphospholipid antibodies. So we order these antibodies as part of a hypercoagulable state, so a patient who has unexplained stroke or ischemic events, we should be thinking about ordering antiphospholipid antibody. The ordering for the antibody is a little bit complex because we have both the functional assay that's testing for the lupus anticoagulant and then in our particular hospital, it's the dilute Russell venom viper time. So the venom of this Russell viper, it causes clots and so if we serially dilute the sample, the amount of time that it takes to clot can be measured. And if you have an anticoagulant in your blood, that's a functional assay that something's in there that's causing the time to be prolonged in the dilute Russell venom Viper time test. We also are going to do the usual tests, which is the PT and PTT as well as testing for the lupus anticoagulant cardiolipin antibodies, and also the glycoprotein IIb. So the antibodies have a binding site on the endothelium, that is the glycoprotein that is the binding site, and so when the antibody interacts with this endothelial glycoprotein, it'll cause the thrombosis. The platelet fibrin will make a thrombus here. Even though it's called the lupus anticoagulant, you don't have to have lupus. It can be any collagen vascular disorder, but lupus is the most predominant and it's not anticoagulant in vivo. So in vivo in the human body, it's procoagulant. It's only anticoagulant in vitro, so even though the test is for anticoagulant, it's actually a prothrombotic in the body. So I ordered the antiphospholipid antibody in patients who have unexplained ophthalmologic thrombotic events. In females we have other criteria that we have to ask about and that's going to be spontaneous miscarriage and it depends if it's in the first ten weeks or so or after, and so you're allowed up to three before the ten weeks. But after that even one event is going to be significant, and we would ask about eclampsia/preeclampsia in pregnancy and placental insufficiency. A lot of patients with antiphospholipid antibody have other markers of the disorder, including the presence of a particular rash on the skin which is reticulated and purple, and we call that livedo reticularis. So we want to be looking for that livedo reticularis. It's especially prominent the lower extremities. So you need to think about antiphospholipid antibody in unexplained thrombotic events and cryptogenic ischemic events, especially in the setting of recurrent PE or recurrent DVT. Spontaneous miscarriages in females, eclampsia/preeclampsia/placental insufficiency. And we're going to test with the functional assays for the lupus anticoagulant, including the diluted Russell venom Viper time, PT PTT, the usual things. And then measurements of both the cardiolipin antibody and the glycoprotein, which is the binding site on the endothelium. |
| Date |
2021-04 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-5890 |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6k70fq0 |
| Setname |
ehsl_novel_lee |
| ID |
1680584 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6k70fq0 |
