SCCM Resource Library-Antiphospholipid Syndromes

Video Transcription

Video Summary

Dr. P.J. Miller, a specialist in internal medicine, pediatrics, hematology, and critical care, discussed antiphospholipid antibody syndromes in the intensive care unit (ICU). Antiphospholipid antibodies are autoimmune antibodies that target phospholipid binding proteins and can cause widespread thrombotic events. They can occur as a primary condition or secondary to an underlying autoimmune disease, and can be triggered by critical care illnesses. The prevalence of antiphospholipid syndrome is estimated to be 17 to 50 per 100,000 people, and it is associated with various thrombotic events, including DVTs, pregnancy losses, strokes, and myocardial infarctions. Diagnosis can be challenging, especially in the complex ICU environment, but early recognition and treatment are crucial for better patient outcomes.<br /><br />Antiphospholipid antibody syndrome typically results in a procoagulant state, with venous thromboses being more common than arterial thromboses. Diagnostic criteria include the presence of vascular thrombosis or pregnancy morbidity, along with the detection of specific antibodies. Initial management involves managing organ dysfunctions, starting anticoagulation, and considering additional treatments such as glucocorticoids or plasma exchange. In catastrophic antiphospholipid antibody syndrome, multiple organ dysfunctions occur simultaneously or within a week, and intensive therapy is required. The association between antiphospholipid antibodies and COVID-19 is still uncertain, with some studies suggesting an increased risk of thrombotic events in patients with high-titer antibodies. Dr. Miller emphasized the importance of taking a step back and considering antiphospholipid antibody syndrome when patients have unexplained or recurrent thrombotic events or pregnancy-related complications.

Asset Subtitle

Immunology, 2022

Asset Caption

Primary immunologic disorders are infrequent but devastating causes of morbidity and mortality in the ICU. The rapidity with which these conditions can progress requires equally swift recognition and intervention. These rare conditions can go unrecognized, leading to increased harm to patients. This session's expert panel will discuss key features of three uncommon but important immunologic disorders for the critical care clinician, with a goal of ensuring quick initiation of needed therapy.

Meta Tag

Content Type Presentation

Knowledge Area Immunology

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Autoimmune Diseases

Year 2022

Keywords

antiphospholipid antibody syndromes

thrombotic events

diagnosis

organ dysfunctions

anticoagulation

COVID-19

high-titer antibodies

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