The antiphospholipid syndrome

Description

Antiphospholipid (ANTE-fos-fo-LIP-id) is a condition in which the immune system mistakenly creates antibodies that attack the tissues of the body. These antibodies can cause blood clots to form in veins and arteries.

Blood clots can form in the legs, lungs, and other organs, including the kidneys and the spleen. The clots can lead to a heart attack, stroke, and other conditions. During pregnancy, the antiphospholipid syndrome also can result in miscarriage and fetal death. Some people who have down syndrome have no signs or symptoms.

There is No cure for this rare condition, but medications can reduce the risk of blood clots and miscarriage.

Symptoms

The signs and symptoms of antiphospholipid syndrome may include:

  • Blood clots in the legs (deep vein thrombosis). Signs of deep venous thrombosis (DVT) include pain, swelling, and redness. These clots can travel to the lungs (pulmonary embolism).
  • Repeated miscarriages or stillbirths. Other complications of pregnancy include dangerously high blood pressure (preeclampsia) and preterm delivery.
  • Stroke. A stroke can occur in a young person that has antiphospholipid syndrome, but no known risk factors for cardiovascular disease.
  • Transient ischemic attack (TIA). Similar to a stroke, a transient ischemic attack (TIA) usually lasts only a few minutes and does not cause permanent damage.
  • Rash. Some people develop a red rash with a hair net, a net-like pattern.

Less common signs and symptoms include:

  • The neurological symptoms. Chronic headaches, including migraines; dementia and seizures are possible when a blood clot blocks the flow of blood to certain parts of the brain.
  • Cardiovascular disease. Antiphospholipid syndrome can cause damage to the heart valves.
  • Low blood platelet count (thrombocytopenia). This decrease in the blood cells necessary for blood clotting can cause episodes of bleeding, especially from the nose and gums. Bleeding into the skin that appear as patches of small red spots.

When to see a doctor

Contact your health care provider if you have pain, bleeding from the nose or gums; an unusually heavy menstrual period; vomiting is bright red or looks like coffee grounds, black, tarry stools or bright red stools; or unexplained abdominal pain.

Seek emergency medical attention if you have signs and symptoms of:

  • Stroke. The formation of a blood clot in your brain can cause numbness, weakness or paralysis of the face, arm or leg. You may have difficulty speaking or understanding speech, visual disturbances, and a severe headache.
  • The pulmonary embolism. If a clot lodges in the lung, you may experience sudden shortness of breath, chest pain and cough with blood-stained mucus.
  • Deep vein thrombosis (DVT). The signs and symptoms of DVT's, which include swelling, redness, or pain in a leg or an arm.

Causes

The antiphospholipid syndrome occurs when the immune system mistakenly creates antibodies that make your blood much more likely to clot. Antibodies protect the body against invaders, such as viruses and bacteria.

Antiphospholipid syndrome can be caused by an underlying condition, such as an autoimmune disorder. You may also develop the syndrome, without an underlying cause.

Risk factors

The antiphospholipid syndrome is more common in women than in men. Have another autoimmune disorder, like lupus, increases the risk of antiphospholipid syndrome.

Is it possible to have the antibodies associated with the antiphospholipid syndrome without the development of symptoms or signs. However, having these antibodies increases the risk of developing blood clots, especially if you:

  • To become pregnant
  • They are immobile for a period of time, as to be on bed rest or sitting down for a long flight
  • Surgery
  • The smoke of cigarettes
  • Taking oral contraceptives or estrogen therapy during menopause
  • Have high levels of cholesterol and triglycerides

Complications

The complications of the antiphospholipid syndrome may include:

  • The renal failure. This may be a result of decreased blood flow to the kidneys.
  • Stroke. The decrease in blood flow to a part of your brain can cause a stroke, which may result in permanent neurological damage, such as partial paralysis and loss of speech.
  • Cardiovascular problems. A blood clot in your leg can cause damage to the valves in the veins that keep your blood flow to your heart. This can result in chronic inflammation and discoloration on the bottom of the legs. Another possible complication is damage to the heart.
  • Lung problems. These may include high blood pressure in the lungs and pulmonary embolism.
  • Complications in pregnancy. These may include spontaneous abortion, fetal death, preterm labor, slow fetal growth, and high blood pressure during pregnancy (pre-eclampsia).

Rarely, in severe cases, the antiphospholipid syndrome can lead to damage of multiple organs in a short period of time.

The antiphospholipid syndrome

Diagnosis

If you have had episodes of blood clots or pregnancy loss that is not explained by known health conditions, your doctor may schedule regular blood tests to check clotting and the presence of antibodies associated with the antiphospholipid syndrome.

To confirm a diagnosis of antiphospholipid syndrome, the antibodies appear in the blood at least twice, in tests conducted 12 or more weeks apart.

You may have antiphospholipid antibodies (apl) and never develop any signs or symptoms. A diagnosis of antiphospholipid syndrome was made only when these antibodies cause health problems.

Treatment

If you have blood clots standard, the initial treatment consists of a combination of blood-thinning medications. The most common are heparin and warfarin (Jantoven). Heparin is fast-acting, and are delivered through injections. Warfarin comes in the form of a pill and it takes several days to take effect. Aspirin is also a blood thinner.

When you are taking blood thinners, you have a higher risk of bleeding episodes. Your doctor will check your dose with blood tests to make sure that your blood is able to clot enough to stop the bleeding from a cut or bleeding under the skin of a bruise.

There is some evidence that other drugs might be useful in the treatment of antiphospholipid syndrome. These include hydroxychloroquine (Plaquenil®), rituximab (Rituxan) and statins. More studies are needed.

Treatment during pregnancy

It is possible to have a successful pregnancy if you have antiphospholipid syndrome, especially with the treatment. Generally, treatment includes heparin or heparin with aspirin. Warfarin is not given to pregnant women since it can affect the fetus.

Self-care

Depending on your plan of treatment for the antiphospholipid syndrome, there are other steps you can take to protect your health. If you take blood-thinning medications, be very careful to avoid injury and to avoid bleeding.

  • Avoid contact sports or other activities that may cause bruising or injury, or cause a fall.
  • The use of a soft toothbrush and waxed thread.
  • Shaving with an electric razor.
  • Be especially careful when using knives, scissors and other sharp tools.
  • Women should avoid the use of estrogen therapy for contraception or menopause.

Food and dietary supplements

Some foods and medicines can affect how well your blood thinners work. Ask your health care provider for guidance about:

  • Safe food choices. Vitamin K can reduce the effectiveness of warfarin, but not other blood thinners. You might need to avoid the consumption of large amounts of vitamin K-rich foods like avocado, broccoli, Brussels sprouts, cabbage, leafy green vegetables and chickpeas. Alcohol may increase warfarin's blood-thinning effect. Ask your doctor if you need to limit or avoid the consumption of alcohol.
  • Sure the medications and dietary supplements. Certain medicines, vitamins, and herbal products can interact dangerously with warfarin. These include some of the pain relievers, cold medicines, remedies for the stomach or multivitamins, as well as garlic, ginkgo, and green tea.

Preparing for your appointment

In most cases, the complications of the antiphospholipid syndrome — such as deep vein thrombosis (DVT), stroke or the loss of a pregnancy — will be asked to seek medical attention. Depending on the complication, it is likely that you see a specialist in vascular disease, obstetrics, or hematology.

Here's some information to help you prepare for your appointment.

What you can do

Be aware of any pre-appointment restrictions. When you make the appointment, ask if there is something that you need to do beforehand. Make a list of:

  • Their signs or symptoms and when they began
  • Key personal information, including major recent events or changes in their life
  • Key medical information, including other conditions or infections that have, and family medical history, especially of close relatives who have had the antiphospholipid syndrome
  • All the drugs, vitamins, and other supplements that you take, including over-dose
  • Questions to ask your doctor

Have a friend or family member, if possible, to help you remember the information that is obtained.

For the antiphospholipid syndrome, some questions to ask your doctor include:

  • What is the most likely cause of my symptoms?
  • What tests do I need?
  • What treatment do you recommend it?
  • How will we know if the treatment is working?
  • How this condition increases my risk of other health problems you have?
  • How this condition increases my risk of health problems during pregnancy? There are treatments to reduce that risk?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask other questions as well.

What to expect from your doctor

Your doctor may ask you a series of questions, including:

  • Do you have a history of stroke or blood clots?
  • Do you have a history of pregnancy complications, such as high blood pressure, miscarriage, or stillbirth?
  • Do you have lupus or another autoimmune disease?
  • Have you ever been tested for sexually transmitted infections or chronic viral diseases, such as hepatitis?
  • Do you have frequent headaches?
  • Have you noticed a network, a net-like eruptions on the skin of your wrists or knees?
  • Do you smoke?
Symptoms and treatment of the Antiphospholipid syndrome