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Thrombotic Microangiopathies In Systemic Lupus Erythematosus

Dr. Laurent ARNAUD @Lupusreference

#TMAs #Thrombotic #Microangiopathies #Systemic #Lupus #Erythematosus #SLE #hematology
Microangiopathies In Systemic Lupus ... Erythematosus #SLE #hematology ... #rheumatology # ... differential #diagnosis ... #causes
Dyspnea - Differential Diagnosis Framework

Cardiovascular Causes of Dyspnea:
 • Myocardium:
	- Heart failure
	- CAD/ACS
	- Valvulopathy
 • Electrical:
	-
- Differential Diagnosis ... - Water - Pus ... Hepatopulmonary syndrome ... Barre - ALS - Transverse ... myelitis • Hematology
Skin Conditions Associated with Joint Pain

Rash
	• Human parvovirus B19 infection

Malar rash
	• SLE
	• Human parvovirus B19 infection
	•
Antiphospholipid-antibody syndrome ... lesions • Discoid lupus ... Sarcoidosis #dermatology ... #differential #diagnosis ... #rheumatology
Purpura - Differential Diagnosis Framework

Non-blanchable, dark red to purple, hemorrhagic skin lesions that result from leakage
- Differential Diagnosis ... Kasabach-Merritt syndrome ... deficiencies - PNH ... #hematology #rheumatology ... #nonpalpable #dermatology
Causes of Hypocomplementemia - CHAMPS Mnemonic
C - Cryoglobulinemia (85%), C3 glomerulopathy, cirrhosis
H - Heavy Chain deposition
Causes of Hypocomplementemia ... antiphospholipid syndrome ... S - Systemic Lupus ... CHAMPS #Mnemonic #diagnosis ... #differential #hematology
Diagnostic Framework for Hemolysis - Intravascular vs Extravascular Causes
Intravascular Hemolysis:
 • Mechanical Trauma (Microangiopathic hemolytic anemia):
Diagnostic Framework ... Extravascular Causes ... hemoglobinuria (PNH ... usually IgG) (e.g. lupus ... #hematology #anemia
CNS Manifestations of Systemic Lupus Erythematosus (SLE)

Clinical Manifestations: Demyelinating Syndrome, Headache, Movement disorders, Seizure disorders, Aseptic
Demyelinating Syndrome ... autoantibodies that will cause ... permeability Diagnosis ... #neurology #rheumatology ... #cerebritis #diagnosis
Recurrent / Breakthrough DVT During Anticoagulation

Subtherapeutic Anticoagulation
Hypercoagulable State 
 - Antithrombin deficiency 
 - Hypercoagulability ot
APLS - MPN/PNH ... Structural - Pelvic masses ... - May-Thurner syndrome ... anticoagulation #hematology
SLE (Systemic Lupus Erythematosus)

Suspect:
Clinical evidence of (fatigue, rash, photosensitivity, inflammatory arthritis, weight loss, and fever) and
Differential Diagnosis ... Non-autoimmune rheumatologic ... • May involve PNS ... neuropathy • Transverse ... #Rheumatology
Pancytopenia - Differential Diagnosis

Congenital Diseases:
• GATA2 deficiency
• Fanconi’s anemia
• Wiskott-Aldrich syndrome
• Ribosomopathy or telomeropathy

Cancer:
• Leukemia
• Lymphoma

Inflammatory
- Differential Diagnosis ... Wiskott-Aldrich syndrome ... Diseases: • Systemic lupus ... #Differential #Diagnosis ... #Hematology