Anaesthetic implications of the anti-cardiolipin antibody syndrome

The anti-cardiolipin antibody syndrome (or anti-phospholipid antibody syndrome) is characterized by the presence of autoantibodies to phospholipids. Its major association is with systemic lupus erythematosus. It is characterized further by in vitro prolongation of phospholipid-dependent coagulation tests. However, in vivo it is associated with a markedly increased incidence of thrombosis, both arterial and venous. We describe the case of a 36-yr-old female patient with the anti-cardiolipin antibody syndrome who presented initially for diagnostic laparoscopy and later for exploratory laparotomy. Her postoperative course after the first general anaesthetic was complicated by disseminated intravascular coagulation and adult respiratory distress syndrome. After the second operation, she deteriorated further with worsening cardiac, renal and respiratory function and eventually died. As far as we are aware, this is the first reported case of the anti-cardiolipin antibody syndrome in anaesthetic literature. Further aspects of this puzzling condition and its anaesthetic implications are discussed.