Antiphospholipid antibody
Antiphospholipid syndrome is a disorder of coagulation, and causes thrombosis in both arteries and veins. It is occasionally referred to as Hughes' syndrome after the Rheumatologist Dr Graham R.V. Hughes (St Thomas' Hospital, London, UK).
Signs and symptoms
The presence of antiphospholipid antibodies (APLAs) is suggested by thrombosis (arterial or venous) and recurrent miscarriage (especially in the second trimester, but often earlier). Other common findings, although not part of the classification, are thrombocytopenia (low platelet count) and livedo reticularis (a skin condition).
APLAs occur in the context of a number of diseases, most notably Systemic Lupus Erythematosus (SLE). One can only speak of Antiphospolipid Syndrome when there are no other symptoms of one of these diseases (e.g. arthritis suggestive of SLE). A significant number of patients with the syndrome will eventually develop SLE, but most never get signs of this disease.
Laboratory
Antiphospholipid syndrome is tested for in the laboratory by two tests of coagulation. The person will have a prolonged immunological test which detects if there are antibodies in the plasma that react with Full blood count
Pathogenesis
Antiphospholipid syndrome is an autoimmune disease, in which antibodies react against anionic phospholipids on cell membranes. Being an autoimmune disease, it is more common in women than in men. There is no definite cause.
Treatment
Often, this disease is treated by giving aspirin to inhibit platelet activation, and/or warfarin as an anticoagulant.
During pregnancy, heparin is used during because of warfarin's teratogenicity.
Women with recurrent miscarriage are often advised to take aspirin and to start heparin (or low molecular weight heparin) treatment after missing a period. This is the most effective treatment at the moment.
Further reading
