2.2 Catastrophic antiphospholipid syndrome
cAPS is characterized by microthromboses involving at least three organs
within a week and is a rare but severe complication of APS. It affects
about 1% of APS patients and the mortality rate reaches 36%.
Agmon-Levin et al. demonstrated that hyperferritinemia can be found in
patients with primary APS and that it correlates with cAPS (71% of cAPS
had hyperferritinemia) (55). Similarly, in SLE patients,
hyperferritinemia correlates with thrombocytopenia, the presence of
lupus anticoagulant and of anti-cardiolipin antibodies, suggesting it
could be an early marker for secondary APS (56). An emerging
complication occurring in COVID-19 is coagulopathy and possible
thrombotic microangiopathy (TMA) (57). A case of COVID-19 and
antiphospholipid antibodies with multiple infarcts has been recently
described. Interestingly, markedly elevated ferritin was found also in
this patient, strikingly reinforcing the connection between infection,
coagulopathy and hyperferritinemia (58).