by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Antiphospholipid Syndrome (APS) is a disorder in which blood clots form in the veins or arteries as a result of the presence of abnormal antibodies.
APS can present in a variety of ways. Among them are: blood clots (thromboses) in leg or arm veins and/or arteries, blood clots which travel to the lungs (pulmonary emboli); sudden loss of vision, occasional episodes of numbness, tingling, or weakness in the face or limbs, stroke, seizures, and recurrent miscarriages. All of these symptoms are the result of blood clots occurring in small to medium sized blood vessels. Most people affected with this disorder have only one or two of any of these symptoms. They are however at risk for developing additional symptoms if not treated appropriately or monitored by a physician knowledgeable about the disorder.
It is still unclear as to why people with this APS have a tendency to clot more easily. Antibodies are proteins produced by the body's immune system to remove foreign proteins, bacteria and viruses. In a person with antiphospholipid syndrome, antibodies are present in blood, which appear to react with cell membranes.
This causes abnormalities in the clotting system. For example, an antibody may interact with a platelet, causing the platelet to release its contents and form a clot. Antibodies also may attach to cells that line blood vessels. This will cause the normally non-reactive surface to become reactive to blood and a clot will form.
In both situations, these antibodies bind to sites on cells normally occupied by blood factors. When these factors can no longer bind to the cells because their sites are occupied by the antibodies, the blood begins to clot more easily.
The creation of an antibody against one's own body or self that causes damage is termed an "autoimmune" disorder. Common autoimmune diseases include systemic lupus erythematosus (SLE), certain types of thyroid disease, rheumatoid arthritis and vasculitis.
Patients taking certain medications such as Dilantin, phenothiazines, or hydralazine may develop APS. Antiphospholipid antibodies can appear for a short time during a viral infection and may disappear soon after the viral infection is completely resolved. Most often, however, antiphospholipid antibodies are found at with no specific underlying reason.
There is no one test that can make the diagnosis of antiphospholipid syndrome. Generally, a series of blood tests that look for abnormal blood clotting and antibodies are performed.
The lupus anticoagulant is a test designed to look for a speific abnormal clotting protein. The name lupus anticoagulant is a misnomer since patients who test positive for a lupus anticoagulant generally have a tendency to clot more easily. The same is true for another abnormal protein called the anti-cardiolipin antibody. The presence of either of these two abnormal proteins combined with clinical symptoms makes the diagnosis of APS. Other tests that are sometimes ordered include activated partial thromboplastin time, prothrombin time, Russell anti-venom viper time, and a few others depending on the laboratory.
Treatment of APS is generally tailored for each patient depending on his or her degree of symptoms. Patients who have had blood clots in the veins or arteries will generally need to receive anti-clotting drugs such as warfarin or heparin.
If clotting is severe, aspirin may be prescribed in addition to the warfarin or heparin. If the patient also has an associated autoimmune disorder, that condition will requrie specific treatment, generally with immunosuppressive therapy.
Any woman with APS considering pregnancy is advised to seek high-risk pregnancy advice and to consult a hematologist or other specialist with knowledge of bleeding disorders prior to conceiving. Patients with a history of recurrent spontaneous abortions may require intravenous (IV) or subcutaneous heparin or oral aspirin during their pregnancy in order to prevent miscarriage due to clotting of blood vessels in the placenta.
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