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Increased Response:
 

1) ENDOTHELIAL CELL (EC) Activation:

vWF Antigen (EC damage)

TF (Tissue Factor) on EC Surface.

Binding of Monocytes by TF, CD36,

TNF expression on EC surface.

ICAMs, VCAMs on EC surface.

uptake of Oxidized LDL (B₂GPI is an antiatherosclerotic protein).
 

2) PLATELET (Plt) Activation:

Platelet activation.

Thromboxane (TxA₂) production.

P-Selectin (from alpha granules) on platelet surface.

PS (PhosphatidylSerine) & PE (PhosphatidylEthanolamine) on platelet surface.
 

3) Acquired APC Restance-like Syndrome:

Factor V inhibitor.
 

4) Neurological Involvement:

TIA (mitral valve thickening with platelet activation, throwing off microthrombi).

Strokes

Dementia, Seizures.

Migraines
 

5) FIBRIN DEPOSITION:

Fibrinogen levels.

Markers of Cascade Activation (MOCA)

F1+2, TATs, Soluble Fibrin Monomer (SFM).

Low grade DIC (compensated DIC)

Shistocytes
 

6) MISC Apsects:

APOPTOSIS (Programmed cell death via PS expression on cell surface).

Renal Transplant Failure due to APS antibodies (40% failure rate).

Hyper IMMUNE Reaction (Eosinophilia, Positive ANAs, DNA,etc.)
 

Decreased Response:
 

1) Thrombocytopenia:

Plt Count (30% patients <100,000 count)

2) ENDOTHELIAL CELLS:

PGI₂ production.

IL-3 production

Thrombomodulin (TM) expression on cell surface.

T/TM Complexes on cell surface.
 

3) Protein C Activation:

PC -> APC

P C activation due to T/TM complexes.
 

4) Prothrombinemia:

II by anti-prothrombin antibody.
 

5) Beta ₂-Glycoprotein I (B₂GPI)

B₂GPI by anti-B₂GPI antibody.
 

6) Annexin V (Placental Anticoagulant Protein I):

Annexin V by anti-annexin antibody.
 

7) Decreased FIBRINOLYSIS:

tPA (tissue plasminogen activator)

PAI₁ (plasminogen activator inhibitor)
 

¹ LUPUS: 5, Oct, 96, p 343-558. Special Issue-7th International Symposium on AntiPhospholipid Antibodies.New Orleans, LA, Oct 9-13, 1996.