Lupus Anticoagulants

OVERVIEW

Lupus Anticoagulants

  • antibodies that block phospholipids surfaces important for coagulation
  • increase APTT
  • prolonged APTT does not correct with a 1:1 mix of normal platelet-free plasma
  • correction of clotting time after addition of excess phospholipids confirms the presence of LA

-> result in acquired hypercoagulability due to poorly understood actions ? alteration of the regulation of haemostasis and endothelial cell injury

ASSOCIATIONS

  • recurrent venous and arterial thromboembolism
  • repeated miscarriages
  • bleeding in conjunction with thrombocytopenia
  • autoimmune disease (SLE, IBD, tumours)
  • infections – e.g. mycoplasma, EBV, syphilis, and hepatitis C (may be transient, with lupus anticoagulant resolving after treatment of infection)
  • drugs (phenothiazines, phenytoin, hydralazine, quinine, amoxicillin)

MANAGEMENT

  • anticoagulation and DVT prophylaxis important
  • thrombosis/emboli may be a reason for admission or complication during stay (PE, venous sinus thrombosis, MI, CVA)
  • as no single test can detect all antiphospholipid antibodies, consensus guidelines recommend screening for LA with 2 or more phospholipis-dependent coagulation tests that work using different principles:

(1) APTT
(2) dilute Russell viper venom time
(3) silica clotting time
(4) kaolin clotting time
(5) dilute PT
(6) textarin time
(7) taipan time


CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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