Health Dictionary
Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
Differentiating Antiphospholipid syndrome from other diseases
Introduction
Overview
Overview
Antiphospholipid syndrome should be differentiated from conditions such as hemolytic uremic syndrome–thrombotic thrombocytopenic purpura (HUS-TTP), disseminated intravascular coagulation (DIC), paroxysmal nocturnal hemoglobinuria, SLE, HELLP syndrome and other myeloproliferative diseases.
Differentiating Antiphospholipid antibody syndrome from other Diseases
Differentiating Antiphospholipid antibody syndrome from other Diseases
- Hemolytic uremic syndrome–Thrombotic thrombocytopenic purpura (HUS-TTP)
- Disseminated Intravascular Coagulation (DIC)
- paroxysmal nocturnal hemoglobinuria
- SLE
- HELLP syndrome
- Myeloproliferative diseases
Abbreviations: ABG= Arterial blood gas, ANA= Antinuclear antibody, ANP= Atrial natriuretic peptide, ASO= Antistreptolysin O antibody, BNP= Brain natriuretic peptide, CBC= Complete blood count, COPD= Chronic obstructive pulmonary disease, CRP= C-reactive protein, CT= Computed tomography, CXR= Chest X-ray, DVT= Deep vein thrombosis, ESR= Erythrocyte sedimentation rate, HRCT= High Resolution CT, IgE= Immunoglobulin E, LDH= Lactate dehydrogenase, PCWP= Pulmonary capillary wedge pressure, PCR= Polymerase chain reaction, PFT= Pulmonary function test.
| Diseases | Clinical manifestations | Para-clinical findings | Gold standard | Additional findings | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Symptoms | Physical examination | |||||||||||||||||
| Lab Findings | Imaging | Histopathology | ||||||||||||||||
| Dyspnea | Fever | Weight loss | Arthralgia | Skin manifestation | Organomegaly | Focal neurological disorder | CBC | ESR | Antibodies | Other | CT scan | Other | ||||||
| Antiphospholipid syndrome | + | + | – | – | Livedo reticularis, palpable purpura, leg ulcers, raynaud phenomena | hepatomegaly, | Stroke, transient ischemic attack | Schistocytes on peripheral smear,Thrombocytopenia, Hemolytic anemia | ↑ | Lupus anticoagulant,anticardiolipin antibodies | – | Stroke, | Doppler ultrasonography for recurrent DVT | Noninflammatory bland thrombosis without perivascular inflammation | Hx of thrombosis and antiphospholipid antibodies | Miscarriage, Pulmonary hypertension | ||
| Systemic lupus erythematosus (SLE) | + |  Leukopenia, Lymphopenia, Anemia,  Thrombocytopenia | ↑ | Anti dsDNA, ANA | ↑Cr or BUN,
↑ALT or AST, Proteinuria |
Interstitial lung disease, Pneumonitis, Pulmonary emboli, Alveolar hemorrhage | Central nervous system (CNS) lupuswhite-matter changes in MRI | Staging lupus nephritis | Anti-dsDNA antibody test | Skin rashes or photosensitivity | ||||||||
| Thrombosis | Thrombophilia | DIC | + | + | – | +/- |  Acral cyanosis, Hemorrhagic skin infarctions | – | + | Thrombocytopenia, Schistocytes | ↑ | – | ↑D-dimer, aPTT and PT | Intracranial hemorrhage | – | Ischemia and necrosis due to fibrin deposition in small and medium-sized vessels | Clinical findings coupled with laboratory abnormalities | – |
| HUS | + | + | – | + | Liver/spleen swelling | + | Anemia, | ↑ | ADAMTS13 | Increased lactate dehydrogenase | Thalami, brainstem, or cerebellumabnormality | Microthrombosesinclude fibrin thrombi that may occlude the glomerular tufts | Clinical findings coupled with laboratory abnormalities | Hematuria, Proteinuria | ||||
| ITP | +/- | – | + | Petechiae | Splenomegaly | + | Anemia, Thrombocytopenia | – | Anti platelet factor 4 antibodies | HIV, ANA | R/O other causes | – | Increased number of normal morphologic megakaryocytes | Clinical findings coupled with thrombocytopenia | Easy bruising, Purpura | |||
| HELLP | – | – | – | – | Hepatomegaly | + | Anemia, Thrombocytopenia, Schistocytes | – | – | ↑Bilirubin, ↓Haptoglobin, ↑LDH, ↑Cr | Cortical hypodense areas in the occipital lobes, Diffuse cerebral edema | Ultrasonography shows Poor fetal growth, Oligohydramnios, Abnormal umbilical artery | – | 24-hour urine study | Seizure, Edema | |||
| Paroxysmal nocturnal hemoglobinuria (PNH) | + | + | – | +/- | Anemia, reticulocytosis,
Increased lactate dehydrogenase (LDH) and bilirubin |
– | Direct antiglobulin (Coombs) testing (DAT) | Increased haptoglobin | – | – | Bone marrow biopsy shows normocellular or hypercellular bone marrow with erythroid hyperplasia | Flow cytometry | ||||||
| Heparin-induced thrombocytopenia (HIT) | + | + | – | – |
|
– | + | Thrombocytopenia | + | Anti-heparin-PF4 IgG |
|
Stroke, pulmonary embolism, mesenteric ischemia, intraabdominal or retroperitoneal bleeding, or acute limb ischemia. | – | Schistocytes | Serotonin release assay | Limb gangrene
Skin necrosis | ||
| Myeloproliferative diseases | + | + | + | + |
|
Splenomegaly | – | ↑WBCs, predominantly neutrophils | + | – |
|
 PET scan- metastasis in bone marrow |  Terminal myeloid cell expansion | Philedelphia chromosome by PCR or BCR/ABL by FISH | ||||
| Recurrent pregnancy loss | Uterine abnormality | – | – | – | – | – | – | – | – | – | – | – | – | – | – | Ultrasound | – | |
| Chromosomal abnormality | – | -/+ | – | – | – | – | – | – | – | – | – | – | – | – | Karyotyping | – | ||
| Hypothyroidism | – | -/+ | – | – | Myxedema
Dry skin |
– | – | – | + | – | – | – |
|
– |
|
| ||
References
References
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Feham Tariq, MD [2]