On the Utility of Nailfold Capillaroscopy in Detecting the Effects of Fibrinaloid Microclots in Diseases Involving Blood Stasis

Abstract

A variety of chronic, inflammatory vascular and autoimmune diseases are accompanied by fibrinaloid microclots. Such diseases reflect endothelial dysfunction and may be detected using a ‘structural’ assay in the form of the fluorescence microscopic or flow ‘clotometry’ analysis of suitably stained platelet-poor plasma. Their amyloid nature and the presence of anti-fibrinolytic molecules therein make the fibrinaloid microclots comparatively resistant to the normal processes of clot degradation. By inhibiting the free flow of blood, the many effects of fibrinaloid microclots include those causing hypoxia, oxidative stress, and ‘blood stasis’ in the microcirculation. Nailfold capillaroscopy is an established observational technique (with both ‘structural’ and ‘functional’ elements) for assessing the microcirculation, and it is thus of interest to establish whether it too demonstrates changes when these syndromes are diagnosed. All diseases in which both methods have been applied show both the presence of fibrinaloid microclots and changes in capillary properties, indicating the complementary value of the structural and functional assays. This also suggests the potential value of nailfold capillaroscopy in a variety of other diseases involving coagulopathies or a deficient microcirculation, which has been little studied to date.

Keywords

Nailfold capillaroscopy / Nailfold videocapillaroscopy / Fibrinaloid microclots / Microcirculation / Inflammation / Coagulopathies / Blood stasis / Vascular and immunological disorders

Author Contributions

Conceptualization, D.B.K. & E.P.; Formal Analysis, D.B.K. & E.P.; Resources, D.B.K. & E.P.; Writing—Original Draft Preparation, D.B.K.; Writing—Review & Editing, D.B.K. & E.P.; Visualization, D.B.K. & E.P.; Funding Acquisition, D.B.K. & E.P.

Funding

DBK thanks the Balvi Foundation (grant 18) and the Novo Nordisk Foundation for funding (grant NNF20CC0035580). EP thanks PolyBio Research Foundation and Kanro Foundation for funding. The content and findings reported and illustrated are the sole deduction, view and responsibility of the researchers and do not reflect the official position and sentiments of the funders. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Declaration of Competing Interest

EP is a named inventor on a patent disclosing the use of fluorescence microscopy in Long COVID.

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