Catastrophic antiphospholipid syndrome in pregnancy: a life-threatening condition

Collict, Mandy; Buhagiar, Whitney Sciberras; Mercieca, Cecilia; Thake, John

doi:10.1136/bcr-2019-230863

Cited by 12 publications

(8 citation statements)

References 18 publications

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“…Additionally, TMA presenting during the postpartum period is more suggestive of CM-HUS compared with TTP, 41 and CAPS has been reported to occur postpartum. 56 Given the diagnostic challenges, the International Working Group on Pregnancy-Related Thrombotic Microangiopathies proposed a step-by-step approach to rule in or out all possible causes of pregnancy-associated TMAs. 64 Besides the common laboratory evaluation of a complete blood count, comprehensive metabolic panel and hemolysis markers (LDH, haptoglobin, reticulocytes), the list of additional tests suggested in the initial workup by the working group and the possible diagnoses are shown in Table 2.…”

Section: Differentiating and Making The Diagnosismentioning

confidence: 99%

“…Among cases of CAPS in pregnancy, a wide variety of organs, including the heart, kidneys, skin, spleen, brain, adrenals, lungs, pancreas, and eyes, have been compromised. 56 CAPS should be considered in the differential in individuals who are pregnant with severe organ involvement or multi-organ involvement. The presence of antiphospholipid antibodies establishes the diagnosis.…”

Section: Catastrophic Antiphospholipid Syndromementioning

confidence: 99%

“…Additionally, TMA presenting during the postpartum period is more suggestive of CM-HUS compared with TTP, 41 and CAPS has been reported to occur postpartum. 56…”

Section: Differentiating and Making The Diagnosismentioning

confidence: 99%

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Differentiating and Managing Rare Thrombotic Microangiopathies During Pregnancy and Postpartum

Lim

Abou‐Ismail

Branch

2022

Obstetrics &Amp; Gynecology

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The most common thrombotic microangiopathy (TMA) of pregnancy is the well-recognized syndrome of preeclampsia with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. However, rare TMAs, including thrombotic thrombocytopenic purpura, complement-mediated hemolytic-uremic syndrome, and catastrophic antiphospholipid syndrome, may occur during pregnancy or postpartum and present with features similar to those of preeclampsia with severe features. Early recognition and treatment of these infrequently encountered conditions are key for avoiding serious maternal morbidities with long-term sequelae and possible maternal or fetal death. Differentiating between preeclampsia with severe features and these rare TMAs is diagnostically challenging as there is significant overlap in their clinical and laboratory presentation. Given the rarity of these TMAs, high-quality evidencebased recommendations on diagnosis and management during pregnancy are lacking. Using current objective information and recommendations from working groups, this report provides practical clinical approaches to diagnose and manage these rare TMAs. This report also discusses how to manage individuals with a history of these rare TMAs who are planning to conceive. To optimize favorable outcomes, a multidisciplinary approach including obstetricians, maternalfetal medicine specialists, hematologists, and nephrologists alongside close clinical and laboratory monitoring is vital.

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Section: Differentiating and Making The Diagnosismentioning

confidence: 99%

Section: Catastrophic Antiphospholipid Syndromementioning

confidence: 99%

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Differentiating and Managing Rare Thrombotic Microangiopathies During Pregnancy and Postpartum

Lim

Abou‐Ismail

Branch

2022

Obstetrics &Amp; Gynecology

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“…Antiphospholipid syndrome (APS) is an autoantibody-mediated acquired thrombophilia that is characterized by recurrent vascular thrombosis, thrombocytopenia and recurrent fetal loss, as well as the presence of three main antiphospholipid antibodies (anticardiolipin, lupus anticoagulant and antibeta2-glycoprotein). [2] , [5] …”

Section: Introductionmentioning

confidence: 99%

Catastrophic antiphospholipid syndrome during pregnancy

Carrasco

Triana

García

et al. 2021

European Journal of Obstetrics & Gynecology and Reproductiv

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Catastrophic antiphospholipid syndrome (CAPS) is an uncommon and the most severe form of antiphospholipid syndrome (APS). A 33-week pregnant patient with Klippel-Trenaunay syndrome, past SARS-CoV-2 infection and type I fetal growth restriction with shortening of the fetal long bone was diagnosed in our center with a probable CAPS. Cesarean section was performed four days after the diagnosis due to the torpid evolution of the patient. Clinical improvement was noted a few days later and the mother and baby were discharged within a week. We review the current literature on CAPS during pregnancy and provide an updated view.

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“…A ntiphospholipid syndrome (APS) is an autoimmune disease characterized by the presen ce of antibodies to negatively charged membrane phospholipids (aPL) in the blood [1][2][3][4]. Antibodies and cell membrane phospholipids interaction causes conformational and metabolic changes in membranes, cell dysfunction and blood clotting disorders.…”

mentioning

confidence: 99%