title: Catastrophic antiphospholipid syndrome and heparin-induced thrombocytopenia-related diseases or chance association?
abstract: Antiphospholipid syndrome (APS) and heparin-induced thrombocytopenia (HIT) are thrombotic disorders due to specific autoimmune-mediated antibodies. Catastrophic APS (CAPS), also known as Asherman's syndrome, is a life-threatening severe form of APS. Diagnostic criteria for CAPS include the development of a thrombotic event of three or more organs in less than a week with the presence of antiphospholipid antibodies and microvascular thrombosis on histology. Thrombocytopenia is seen in more than 60% of cases of CAPS. HIT is a life-threatening disorder with the clinical presentation of thrombocytopenia and arterial or venous thrombosis in patients who develop antibodies to heparin and platelet factor 4 typically within 10 days after starting heparin treatment. Due to the multiple similarities in clinical features and pathophysiology of CAPS and HIT, it has been postulated that these two antibody-mediated disorders may be related. We report two cases in which patients diagnosed with CAPS developed HIT very soon during the same admission as well as a case of a patient initially diagnosed with HIT who presented with CAPS years later.
authors.affiliation: aDepartment of Internal Medicine bDivision of Nephrology, Department of Internal Medicine, Easton Hospital, Drexel University, School of Medicine, Easton, Pennsylvania, USA.
authors.forename: Nay T
authors.initials: NT
authors.lastname: Tun
authors.forename: Mahesh
authors.initials: M
authors.lastname: Krishnamurthy
authors.forename: Richard
authors.initials: R
authors.lastname: Snyder
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects*; D016736:Antiphospholipid Syndrome / Q000097:blood*; D005260:Female; D006175:Gynatresia / Q000097:blood*; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D013921:Thrombocytopenia / Q000139:chemically induced*
chemical_list: D000925:Anticoagulants; D006493:Heparin