Pulmonary thromboembolism

Thrombophlebitis involving the veins of the lower extremities occurs in 5 to 12 per cent of patients with SLE. Predisposing factors include chronic low-grade disseminated intravascular coagulation, angiitis of small vessels, prolonged bed rest, and increased thromboplastin generation. Among the etiologies for thromboembolic phenomenon in patients with SLE is the antiphospholipid antibody syndrome, which refers to a spectrum of autoantibodies, including lupus anticoagulant antibodies and anticardiolipin antibodies, that bind to negatively charged phospholipids. The antiphospholipid antibody syndrome plays a major role in causing the thromboembolic phenomenon in the extremities and the pulmonary vasculature. The syndrome is characterized by a prolonged activated partial thromboplastin time in association with otherwise normal clotting and platelet counts, the presence of anticardiolipin antibody, and a false-positive VDRL test. Recurrent thromboembolism and pulmonary emboli complicated by pulmonary hypertension have been described in patients with the lupus anticoagulant syndrome. Long-term anticoagulant therapy is required in these patients. The adult respiratory distress syndrome, caused by extensive small-vessel thrombosis of multiple organs including the lungs, has been described.

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