Table 1.

Laboratory and imaging tests performed after development of acral ischemia

	Tests Performed	Results
Infection	CBC, CRP Blood cultures Echocardiography HBV, HCV	Normal Negative No vegetation or myxoma Negative
Hypercoagulable state	Protein C Protein S Anti- thrombin 3 Platelet PT/aPTT/INT	131% (Normal) 73% (Normal) Normal 280 10 × 3/uL (Normal) Normal
Lymphoproliferative disease	Kappa/Lambda Ratio Beta-2 microglobulin (B2M) LDH SPEP/IFE	1.37 (Normal) 3 mg/L (Mildly elevated) 138 U/L (Normal) Normal
Tumor invasion	CT Chest CT Angiography	No invasion of sympathetic nervous plexus No vascular occlusion, saccular aneurysm or stenosis up to the palmar arch arteries
Autoimmune and inflammatory disease / Thromboangiitis obliterans	ANA ESR CH50 ANCA-c, ANCA-p Cryoglobulin APL ab, Anti-Scl-70 Ab, Anti-dsDNA ab, Anti-U1 RNP Ab, Anti-Sm ab, Anti-Ro/SSA ab Nailfold videocapillaroscopy Skin biopsy	1:80 Homogeneous 70 mm/hr 170 CAE Units (elevated) (Acute phase reactant) Normal Negative (Normal) Not performed Not performed Not performed

Ab: antibodies, APL: antiphospholipid, Anti-Scl-70: topoisomerase I, ANCA-c: Central anti-neutrophil cytoplasmic antibodies, ANCA-p: perinuclear anti- neutrophil cytoplasmic antibodies, Anti-Sm: anti smith antibodies, Anti-Ro/SSA: anti sjögren’s syndrome related antigen A, SPEP: serum protein electrophoresis, IFE: immunofixation electrophoresis