Today we discussed the antiphospolipid antibody syndrome and thromboembolic disease.

A NEJM images in clinical medicine case of phlegmasia cerulea dolens is posted here
Phlegmasia cerulea dolens:

• massive proximal DVT of the leg
  
• complications include severe pain , swelling, cyanosis, edema, venous gangrene, compartment syndrome, and arterial compromise, often followed by circulatory collapse and shock
• one of the few reasons to consider thrombolysis (genearlly catheter directed) or thrombectomy for lower limb DVT

APLA syndrome:

• Recurrent positive testing for an antiphospholipid antibody (>2x >3 months apart)
• Clinical sequlae - usually arterial and/or venous thrombosis or pregnancy loss (either recurrent early loss or single late loss, without other cause)
  

Notes on the lupus anticoagulant:

• causes prolonged aPTT (not always present), the dilute Russell viper venom time (dRVVT), the kaolin clotting time
• prolongation is not reversed during a 50:50 mix test
• patients with this dont always have SLE
  
• the term anticoagulant refers to invitro phenomenon - in vivo these patients are prone to thrombosis