Hematological features and alternate diagnoses in critically ill thrombotic antiphospholipid syndrome patients.
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Azoulay Levi-Dan, Frapard Thomas, Larcher Romaric, Pène Frédéric, Argaud Laurent, Mayaux Julien, Jamme Matthieu, Coudroy Remi, Mathian Alexis, Gibelin Aude, Azoulay Elie, Tandjaoui-Lambiotte Yacine, Dargent Auguste, Beloncle François-Michel, Raphalen Jean-Herlé, Bréchot Nicolas, de Prost Nicolas, Devaquet Jérôme, Contou Damien, Gaugain Samuel, Trouiller Pierre, Grangé Steven, Ledochowski Stanislas, Lemarie Jérémie, Faguer Stanislas, Degos Vincent, Frere Corinne, Quentric Paul, Moyon Quentin, Luyt Charles-Edouard, Combes Alain, Amoura Zahir, Pineton de Chambrun Marc
Аннотация
METHODS: This French, national, multicenter, retrospective study, conducted, from January 2000 to September 2018, included all APS patients admitted to 24 participating centers' ICUs with any new thrombotic manifestation. The prevalence of hematological manifestations and their associated outcomes were studied.
RESULTS: One hundred and thirty-four patients, female 72%, median [IQR] age 45 [34-56] years, with 152 episodes were included. Anemia was present in 95% of episodes and thrombocytopenia in 93%. The lowest values for hemoglobin and platelets were 7.1 [6.3-8.8] g/dL and 38 [21-60] g/L, respectively. The lowest platelet count below 20 g/L was significantly associated with a higher in-ICU mortality rate (50%, p < 0.0001). A thrombotic microangiopathy syndrome (TMA) syndrome was seen in 16 patients (12%) and was associated with higher in-hospital mortality (p = 0.05). Median ADAMTS-13 levels were 44% [27-74]. Anti-ADAMTS13 antibodies were tested in 11 patients and found negative in all. A suspicion of heparin-induced thrombocytopenia (HIT) was raised in 66 patients but only four patients were classified as definite HIT. Disseminated intravascular coagulation (DIC) was seen in 51% of patients.
CONCLUSION: Thrombocytopenia is very frequent in severe APS patients and may be related to TMA, HIT, or DIC. Deciphering the mechanisms of thrombocytopenia is decisive in CAPS patients. Key Points • Thrombocytopenia is the hallmark laboratory finding in CAPS. • A complete thrombotic microangiopathy pattern is infrequent in CAPS patients. • Alternate diagnoses of CAPS, especially heparin-induced thrombocytopenia, need to be adequately investigated.