NBME 22 Antiphospholipid antibodies (NBME Answers)

NBME 22 Answers

nbme22/Block 3/Question#16 (reveal difficulty score)
A 27-year-old woman comes to the physician ...
Antiphospholipid antibodies 🔍 / 📺 / 🌳 / 📖
tags:

+12 upvote downvote
submitted by ∗hayayah(1212)

Pregnancy + Hx of thrombosis --> think antiphospholipid syndrome

The PT and PTT are prolonged d/t interference from the antibodies to phospholipids. Thrombin time normal.

Had to find research articles about it so take it from here and don't waste your time...

monoloco yeah, i’ve never heard of antiphospholipids increasing PT time ... +26

goldenwakosu Not sure if that little detail was to throw us off. I think the point of the question was to ID antiphospholipid syndrome based on the clinical criteria (spontaneous abortion + thrombosis) +5

johnthurtjr I actually went down a rabbit hole with this one recently - essentially in vitro findings =/= in vivo findings, clot-wise with anti-phospholipid antibodies. +4

link981 No mention of lupus anticoagulant, anticardiolipin, or anti Beta 2 antibodies. FA mentios prolonged PTT but nothing on PT. What a piece of shit question. But thanks to the dudes above who explained it +9

yb_26 UWorld mentioned "prolong aPTT (and sometimes PT)" in APS +5

oslerweberrendu @yb_26 Can u please tell the QID because the one I have seen it says, "Although patients often have prolonged ptt (because the antiphospholipid interferes with ptt test), pt is normal." QID: 1298 +1

kevin just to clarify, lupus anticoag is in antiphospholipid and presents with paradoxical increased ptt +/- pt despite increase risk thrombosis +2

+2 upvote downvote
submitted by amphotericin(11)

how would you rule out C) dysfibrinogenemia? I first guessed APS but switched it because of the PT/PTT thing

suckitnbme You should be able to rule it out by the normal Thrombin time. Abnormal fibrinogen would have increased PT/PTT but also increased Thrombin time because the entire pathway is compromised by the inability of fibrinogen to be cleaved to functioning fibrin. +9

+1 upvote downvote
submitted by ∗kms123(2)

How would we rule out antithrombin deficiency?

sd22 PT, PRT, and TT normal in antithrombin deficiency. FA ‘20 pg. 428 +

sd22 PTT* lol autocorrect clearly hasn’t been studying +

+1 upvote downvote
submitted by ∗weirdmed51(30)

Summary (increase -I, NORMAL -N) + APS : PT-I, PTT-I, TT-N + Dysfibrinogenemia: PT-I, PTT-I, TT-I + Protein C defc : PT-N, PTT-N, TT-N

-1 upvote downvote
submitted by ∗rainlad(33)

How do you rule out Protein C deficiency in this case? doesn't that also increase risk of thrombosis and miscarriage?

suckitnbme @rainlad Protein C deficiency doesn't cause elevated PT and aPTT. I believe they're both normal and assays for the disease measure protein C activity. +6

drzed Protein C is an anti-coagulant, so if you lack factor C, then you have MORE clotting factors. This means that the PT and PTT would not be prolonged. +6

Must-See Comments from nbme22

sacredazn on Unrearranged immunoglobulin gene
seagull on Decreased binding of RNA polymerase
seagull on Anticholinergic
liverdietrying on Release of stored thyroid hormone from a ...
keycompany on Negative nitrogen balance
kernicterusthefrog on Displacement
mcl on Area labeled ‘D’
joha961 on Displacement
imgdoc on Area labeled ‘C’ (Abducens nucleus, right)
alwaysanonymous on 25 mL/cm H2O
drdoom on 1 in 600
seagull on Glutamine
bubbles on Acute retroviral infection
yotsubato on Phase variation