antiphospholipid syndrome

Question 1

define antiphospholipid syndrome

Answer 1

An autoimmune disorder characterised by inflammation, thromboembolism, and high levels of antiphospholipid antibodies.

Question 2

risk factors for antiphospholipid syndrome

Answer 2

• Diabetes
• HTN
• Obesity
• Female
• Smoking
• Oestrogen therapy (Menopause)

Question 3

pathophysiology of antiphospholipid syndrome

Answer 3

1. Those with APS make abnormal proteins called antiphospholipid autoantibodies in the blood.
2. These antibodies bind to the phospholipids on the surface of cells, causing inflammation and increasing the risk of thrombosis.
3. This causes blood to flow improperly and can lead to dangerous clotting in arteries and veins
4. problems for a developing fetus and pregnancy miscarriage.

Question 4

what are the specific antiphospholipid antibodies are:

Answer 4

• Lupus anticoagulant
• Anticardiolipin antibodies
• Anti-beta-2 glycoprotein I antibodies

Question 5

what causes antiphospholipid syndrome

Answer 5

can occur on its own
or
2˚ to AI disorder (esp. SLE)

Question 6

what is Catastrophic Antiphospholipid Syndrome

Answer 6

a rare complication, with rapid thrombosis in multiple organs within a few days.
This has a high mortality rate.

Question 7

main features of antiphospholipid syndrome

Answer 7

CLOT:

Clots – usually venous thromboembolism

Livedo reticularis – mottled, lace-like appearance of the skin on lower limbs

Obstetric loss – recurrent miscarriages, pre-eclampsia, and premature births

Thrombocytopenia

Question 8

other features of antiphospholipid syndrome

Answer 8

• Valve disease (non-bacterial growths)
• Aortic and mitral regurgitation/stenosis
• increased risk of arterial and venous thrombosis

Question 9

how to diagnose antiphospholipd syndrome

Answer 9

• FBCs to show thrombocytopenia
• One or more of the following are needed on 2 separate occasions, 12 weeks apart, to confirm the diagnosis:
  1. Anticardiolipin antibodies
  2. Anti-beta-2 glycoprotein I antibodies
  3. Positive lupus anticoagulant assay

Question 10

what can cause a false positive for antiphospholipid syndrome and how to avoid this

Answer 10

Syphilis can cause false-positive tests, so should be excluded using treponemal serology (test for syphilis).

Question 11

how to treat antiphospholipid syndrom

Answer 11

Long-term warfarin with a target INR of 2-3 to prevent thrombosis

Question 12

how to treat antiphospholipid syndrome in pregnancy

Answer 12

Low molecular weight heparin and aspirin are used in pregnancy (warfarin in teratogenic)