Case Report
Catastrophic Antiphospholipid Syndrome with Severe Acute Thrombotic Microangiopathy and Hemorrhagic Complications
| | Analyte | Reference range | Day 1 | Day 17 |
| | Sodium (mmol/liter) | 137–145 | 137 | 141 | | Potassium (mmol/liter) | 3.6–5.0 | 5.9 | 3.9 | | Chloride (mmol/liter) | 98–107 | 107 | 105 | | CO2 (mmol/liter) | 22–30 | 11 | 30 | | Urea nitrogen (mg/dL) | 7–17 | 33 | 88 | | Creatinine (mg/dL) | 0.5–1.4 | 2.8 | 3.3 | | Glucose (mg/dL) | 74–199 | 229 | 145 | | Calcium (mg/dL) | 8.4–10.2 | 7.3 | 8.7 | | Total protein (g/dL) | 6.3–8.2 | 6.3 | 5.5 | | Albumin (g/dL | 3.9–5.0 | 1.8 | 2.9 | | AST (IU/liter) | 15–46 | 58 | 70 | | ALT (IU/liter) | 9–52 | 23 | 30 | | LDH (IU/liter) | 84–246 | 836 | 5235 | | Bilirubin, total (mg/dL) | 0.3–1.3 | 0.4 | 1.9 | | Bilirubin, indirect (mg/dL) | 0.2–0.9 | 0.3 | 1.1 | | Haptoglobin (mg/dL) | 30–200 | 8 | <10 | | Hemoglobin (g/dL) | 12–16 | 4.2 | 10.2 | | Hematocrit (%) | 37–47 | 12.8 | 29.5 | | Leukocyte count (×103/μL) | 4.3–11.0 | 25.3 | 9.9 | | Neutrophils (×103/μL) | 1.5–7.0 | 18.5 | 9.3 | | Lymphocytes (×103/μL) | 1.0–3.7 | 3.3 | 0.3 | | Monocytes (×103/μL) | 0.0–0.7 | 1.3 | 0.25 | | Eosinophils (×103/μL) | 0.0–0.4 | N/A | 0.00 | | Basophils (×103/μL) | 0.0–0.1 | N/A | 0.05 | | Platelet count (×103/μL) | 140–440 | 8 | 9 | | Urinalysis | | | | | Color | Yellow | Dark | Red | | Turbidity | Clear | Cloudy | Cloudy | | pH | 4.6–8.0 | 5.0 | 6.0 | | Specific gravity | 1.001–1.035 | 1.030 | 1.030 | | Glucose | Negative | Negative | 1+ | | Ketones | Negative | Negative | Negative | | Bilirubin | Negative | Negative | 1+ | | Blood | Negative | 3+ | 3+ | | Protein | Negative | 2+ | 3+ | | Nitrites | Negative | Negative | Negative | | Leukocyte esterase | Negative | Positive | Positive | | White blood cells/hpf | 0–2 | 15–25 | >182 | | Red blood cells/hpf | 0–2 | 10–12 | >182 | | Urine protein (mg/dL) | 5–25 | 100 | 1197 | | Urine creatinine (mg/dL) | 20–370 | N/A | 82 | | Urine protein: creatinine | 0.02–0.13 | N/A | 14.6 | | Lupus anticoagulant panel | Negative | N/A | Positive | | Silica clotting test ratio | <1.2 | N/A | <1.2 | | DRVVT ratio | <1.2 | N/A | 1.21 | | Staclot LA clotting time (sec) | <10 | N/A | 12.2 | | Anticardiolipin Ab | Negative | Negative | Negative | | IgG (U/mL) | <10 | 0.4 | 4.1 | | IgM (U/mL) | <10 | N/A | 3.7 | | IgA (U/mL) | <8 | 7.4 | 1.4 | | Anti--glycoprotein I Ab | Negative | Negative | Negative | | IgG (U/mL) | <20 | <9 | <9 | | IgM (U/mL) | <20 | <9 | <9 | | ADAMTS-13 activity (%) | 56–253 | 58 | 59 | | Antiplatelet factor-4 | Negative | N/A | Negative | | CRP (mg/dL) | <1.0 | N/A | 5.3 | | ESR (mm/hour) | 0–20 | 125 | N/A | | Ferritin (ng/mL) | 8–388 | 397 | N/A | | D-Dimer (ng/mL) | 0–230 | 4950 | >5000 | | FDP (μg/mL) | <5 | 5–20 | N/A | | Fibrinogen (mg/dL) | 190–380 | 344 | 228 | | APTT (sec) | 24.5–35.7 | 23.2 | 21.3 | | PT (sec) | 10.1–12.6 | 12.3 | 10.5 | | C3 (mg/dL) | 90–180 | 45 | 64 | | C4 (mg/dL) | 10–40 | 9 | 13 | | ANA titer | <1 : 40 | Positive | 1 : 160 | | Anti-dsDNA Ab (IU/mL) | <5.0 | 85 | 10 | | Antichromatin Ab (IU/mL) | ≤0.9 | >8.0 | Positive | | Anti-Smith Ab (IU/mL) | ≤0.9 | >8.0 | Positive | | Anti-RNP Ab (IU/mL) | ≤0.9 | >8.0 | Positive | | Anti-SSA/Ro Ab (IU/mL) | ≤0.9 | >8.0 | Positive | | Anti-SSB/La Ab (IU/mL) | ≤0.9 | 6.0 | Positive | | Anti-Scl-70 Ab (IU/mL) | ≤0.9 | ≤0.9 | Negative | | Anticentromere Ab (IU/mL) | ≤0.9 | ≤0.9 | Negative | | Anti-Jo-1 IgG | Negative | Negative | Negative | | Antiribosomal Ab | Negative | N/A | Negative | | Anti-GBM Ab (AI) | <1.0 | <1.0 | <1.0 | | ANCA (perinuclear) (AI) | <1.0 | <1.0 | N/A | | ANCA (cytoplasmic) (AI) | <1.0 | 1.3 | N/A | | Antimyeloperoxidase Ab | Negative | N/A | Negative | | Antiproteinase-3 Ab | Negative | N/A | Negative | | Rheumatoid factor (IU/mL) | <14 | N/A | <14 | | CPK (IU/liter) | 38–234 | 128 | 218 | | Alk Phos (IU/liter) | 38–126 | 82 | 50 |
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Values out of the reference range are in bold. Ab: antibody; ADAMTS-13: a disintegrin and metalloprotease with thrombospondin-1—like domains; AI: antibody index; Alk Phos: alkaline phosphatase; ALT: alanine transaminase; ANA: antinuclear antibodies; ANCA: antineutrophil cytoplasmic antibodies; anti-GBM: antiglomerular basement membrane; anti-dsDNA: antidouble stranded DNA; APTT: activated partial thromboplastin time; AST: aspartate transaminase; CO2: carbon dioxide, CPK: creatine phosphokinase; CRP: C-reactive protein; DRVVT: dilute Russell viper venom time; FDP: fibrin degradation products; LDH: lactate dehydrogenase; N/A: not available; PT: prothrombin time; RNP: ribonucleoproteins; Scl-70: scleroderma-70; sec: seconds.
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