Anti-Phospholipid Syndrome

Question 1

pathogenesis

Answer 1

recurrent venous/arterial thrombosis, and/or foetal loss

Question 2

who gets it?

Answer 2

some patients no associated symptoms

in other patients in association with SLE, or another AI disease

Question 3

what effect does it have?

Answer 3

increased frequency of stroke or MI (especially younger)
strokes secondary to in situ thrombosis
- embolization that originates from the valvular lesions of the Libman-Sacks (sterile) endocarditis (may be seen in patients with APS
recurrent PE/thrombosis - pulmonary hypertension
late spontaneous foetal loss (2nd/3rd trimester)
recurrent early foetal loss (10 weeks) also possible
migraine
livedo reticularis - common cutaneous finding

Question 4

how is it investigated?

Answer 4

thrombocytopenia
prolongation of APTT
immunology - lupus anticoagulant, anti-cardiolipin, anti-beta 2 glycoprotein

Question 5

how is it managed?

Answer 5

anti-coagulation for those with an episode of thrombosis
recurrent pregnancy loss - LMWH during pregnancy as warfarin is teratogenic
+ve antibodies without any episode of thrombosis previously - don’t require anti-coagulation