Abstract
Antiphospholipid syndrome (APS) is a relatively new disease and reveals clinical symptoms such as venous thrombosis, arterial thrombosis, habitual abortion and thrombocytopenia. This disease is diagnosed based on lupus anticoagulant or positive IgG and IgM anticardiolipin antibody at the middle level or higher inlaboratory tests.
This report presents the data obtained from a patient with ITP complicated by APS-like disease.
The patient was a 70-year-old woman who suffered from wide-spread hypodermal hemorrhagic spots due to a blow eight years ago. She was examined at a nearby clinic, and found to have thrombocytopenia. Hence, the physician of the clinic introduced her to a university hospital, and she was diagnosed as having ITP.
Since some time in April 1994, the patient had toothache of a third molar. Although she wanted to extract the tooth, she had an experience of hemorrhage after extraction of another third molar in 1992.
In the preoperative examination, the platelet count was low and 4.6×104/μl. In the blood coagulation test, PTT was extended to 200 sec (100 sec for control). In the repeated examination later, APTT was 115 sec and abnormally long (50 sec for normal). In the examination of coagulation factors performed simultaneously, the level of every factor was very low: 25% in F VIII, 23% in F IX, 58% in F XI, and 18% in F XII were observed, indicating an apparent multiple deficiency of coagulation factors. In the APTT supplementation test, the activity of plasma from this patient could not be corrected sufficiently by addition of even 3/4 amount of normal plasma, while the activity of a plasma sample that was known to be deficient of coagulation factors was normalized by addition of 1/4 amount of normal plasma. Hence, the presence of some anticoagulant was strongly suspected. Then, the patient was examined for lupus anticoagulant (LA) and anticardiolipin antibody. LA was found to be positive and anticardiolipin IgG antibody was more than the middle level. Therefore, the illness was considered to be APS.
