The Intern At Work: Internal Medicine 105: So the Clot Thickens - Antiphospholipid Syndrome
Sep 5, 2021
In this engaging discussion, internal medicine resident Stefan Jevtic dives deep into antiphospholipid syndrome (APS), shedding light on its intriguing naming origins. He elaborates on the physiological mechanisms of APS, particularly how it affects pregnant patients. Listeners will gain insights into diagnostic criteria, key symptoms, and effective treatment strategies like anticoagulation therapy. Stefan’s expertise makes complex medical concepts accessible, turning a dense topic into a captivating conversation!
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How A Syphilis Test Revealed APS
- The Wasserman syphilis test used cardiolipin from beef heart, which cross-reacted with antibodies in lupus patients causing false positives.
- This historical finding led to the discovery and naming of antiphospholipid syndrome.
APS Antibodies And The Paradoxical Lab Findings
- Antiphospholipid syndrome (APS) is driven by anticardiolipin, anti-β2 glycoprotein, and the nonspecific inhibitor historically called lupus anticoagulant.
- These antibodies paradoxically prolong in vitro clotting tests while increasing real-world thrombosis risk.
Two-Hit Model Explains APS Activation
- APS likely follows a two-hit model: antibody formation after a trigger and a prothrombotic second hit like inflammation or pregnancy.
- Transient antiphospholipid antibodies often appear during acute infections and may disappear on repeat testing months later.