Antiphospholipid syndrome

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 22, 2016
StartDiseasesAntiphospholipid syndrome

Considered a serious medical condition, antiphospholipid syndrome (APS) is an autoimmune disease that affects an estimated one to five percent of the population. The condition requires careful management and monitoring and can be fatal if allowed to progress unchecked. Though there is no cure for the disease, management techniques make it possible for those with APS to live long, healthy lives with very few lifestyle changes or disruptions.

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Definition & Facts

In those with APS, the immune system fails to recognize certain blood proteins, attacking and destroying them as if they were bacteria or viruses. The destruction of these cells causes blood clots to form which can occur anywhere in the body. These clots can cause serious damage to cells and tissue depending on where they form and can break free, traveling anywhere in the body through the circulatory system. APS can also cause several complications during pregnancy.

Though it is possible to have APS alone, a condition known as primary APS, many with the condition also suffer from rheumatic diseases such as lupus. When APS accompanies other disorders, it is known as secondary APS.

Anyone can be affected by APS, but the disease is much more likely to affect women, with between 75 and 95 percent of those with APS being female. A higher incidence of APS is reported among African-American and Hispanic populations as well, although the reasons for this are unknown. The disorder has been recorded in children as young as 8 months of age but is usually diagnosed in young adults. Persons of any age can be affected, however.

Symptoms & Complaints

The most common symptom of APS is blood clots, which often appear in the legs (deep vein thrombosis) or in both the arms and legs (peripheral arterial thrombosis). If blood clots form in the brain or lungs, pulmonary embolism and stroke are possible. Blindness can occur if a clot affects the blood vessels which supply the eye and other complications can arise due to clots based on their location.

APS can also cause a woman to experience multiple miscarriages or stillbirths and can cause high blood pressure during pregnancy (preeclampsia). Less common symptoms of APS include chronic migraines, poor memory, fatigue, sudden hearing loss, lacy rashes, and heart valve disease.

APS can be fatal if a blood clot makes its way to the lungs, brain or heart. Some people have the condition but fail to show any symptoms until they become pregnant, have surgery, start smoking or remain immobile for a long period of time due to bed rest or a long airplane flight. Symptoms may also appear suddenly after the onset of other medical conditions or when starting certain prescription or over-the-counter medications.

Causes

Some infections can cause the body to create the antibodies that attack blood proteins in APS. These illnesses include HIV, syphilis, hepatitis C, lupus and Lyme disease. Certain medications are also known to have caused APS in some patients including:

While APS is not considered a hereditary disease, genetics may predispose an individual to the condition. Sometimes the cause of APS is unknown and is never determined. This is known as idiopathic APS.

Diagnosis & Tests

APS is diagnosed through a simple blood test. The test is typically administered only if a woman loses multiple pregnancies without explanation or if unexplained blood clots occur two or more times. A patient can ask to be tested if he or she has concerns about APS.

The blood test for APS checks for all of the three of the antibodies that can be present in APS: lupus anticoagulant, anti-cardiolipin antibodies and beta-2 glycoprotein 1 antibodies. If these antibodies are present, the blood test is repeated in 12 weeks or more. An APS diagnosis is confirmed only if these antibodies are found in both blood samples.

Treatment & Therapy

There is no cure for APS, but the condition can be managed. This is typically done with blood thinners such as heparin, warfarin and even aspirin. Thinning the blood helps to prevent dangerous blood clots from forming. Doctors monitor patients on these blood-thinning medications with frequent blood tests and encourage them to avoid rigorous physical activities that could cause bleeding injuries.

Those on blood thinners are also advised to avoid foods rich in Vitamin K, which can affect the way blood thinners work, and to shave with electric razors to reduce the risk of accidental cuts that could result in blood loss.

Some patients have been able to manage their APS with cholesterol medications. Those with APS are strongly encouraged to quit smoking, avoid birth control methods containing estrogen and begin a physician-approved exercise program to promote heart health. Treatment of APS during pregnancy with blood thinners requires careful monitoring but has been shown to successfully reduce the risk of miscarriage, stillbirth and premature birth.

Prevention & Prophylaxis

Because not all of the causes of APS are known, it is not always possible to prevent the condition. The best way to prevent APS is to avoid medications that are know to cause it and take the precautions necessary to avoid preventable diseases such as syphilis and HIV. A healthy diet and exercise regimen both go a long way toward keeping the body in the best possible condition and may help prevent APS to an extent.

Those with family members who have APS should consider having themselves tested so that the condition, if present, can be diagnosed and controlled early. Early detection and management can sometimes prevent blood clots before they happen, allowing patients to avoid potentially fatal clot complications such as stroke. To prevent excessive blood loss and other complications, those with APS should always tell their doctor about their condition and treatment before undergoing any surgery or other medical procedure.