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

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.