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APLAR Blackboard (APS)
APLAR Blackboard (APS)
Step
1
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2
50%
Question 1
Which of the following does NOT belong to the “extra-criteria” manifestation of antiphospholipid syndrome?
Question 1
A. Livedo reticularis
B. Valvular heart disease
C. Thrombocytopenia
D. Pregnant loss at 15th gestational week
Answer with a detailed explanation
D. Pregnant loss at 15th gestational week
Antiphospholipid syndrome (APS) is a disorder characterized by thrombotic and/or obstetric events in patients with persistent positive antiphospholipid antibodies (aPL), namely lupus anticoagulant [LA], anticardiolipin antibody [aCL] and anti-β2 glycoprotein-I antibody [anti-β2GPI]. The most used diagnosis criteria of APS is the 2006 revised Sydney criteria, which include vascular thrombosis and pregnant morbidity as the “clinical criteria”. But the clinical symptoms of APS include many non-thrombotic manifestations, the so-called “extra-criteria” manifestations, including thrombocytopenia, aPL nephropathy, livedo reticularis, valvular heart disease, neurological manifestations and so on.
Reference
Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS)[J]. J Thromb Haemost, 2006, 4(2): 295-306.
Sciascia S, Amigo MC, Roccatello D, et al. Diagnosing antiphospholipid syndrome: 'extra-criteria' manifestations and technical advances[J]. Nat Rev Rheumatol, 2017, 13(9): 548-560.
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Question 2
Which of the following clinical manifestation is NOT a clinical manifestation of placental insufficiency in the third trimester?
Question 2
A. Intrauterine growth restriction (IUGR)
B. Absent end-diastolic flow in the umbilical artery
C. Placental abruption
D. Oligohydramnios
Answer with a detailed explanation
C. Placental abruption
According to the 2006 revised Sydney criteria for APS, generally accepted features of placental insufficiency include (i) abnormal or non-reassuring fetal surveillance test(s), e.g. a non-reactive non-stress test, suggestive of fetal hypoxemia, (ii) abnormal Doppler flow velocimetry waveform analysis suggestive of fetal hypoxemia, e.g. absent end-diastolic flow in the umbilical artery, (iii) oligohydramnios, e.g. an amniotic fluid index of 5 cm or less, or (iv) a postnatal birth weight less than the 10th percentile for the gestational age.
Reference
Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS)[J]. J Thromb Haemost, 2006, 4(2): 295-306.
Alijotas-Reig J, Esteve-Valverde E, Anunciacion-Llunell A, et al. Pathogenesis, Diagnosis and Management of Obstetric Antiphospholipid Syndrome: A Comprehensive Review[J]. J Clin Med, 2022, 11(3).
By Prof Jiuliang Zhao, Department of Rheumatology, Peking Union Medical College Hospital, Beijing, China
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