APAS Flashcards
an autoimmune disease characterized by the
production of antiphospholipid antibodies
Antiphospholipid Syndrome
associated with pregnancy complications that
include fetal loss, fetal growth restriction,
preeclampsia, thrombosis, and autoimmune
thrombocytopenia
antiphospholipid antibody syndrome
Persistently elevated levels of
antibodies directed against
membrane anionic phospholipids
(anticardiolipin (aCL) antibody) or
their associated plasma proteins or
evidence of a circulating
anticoagulant
antiphospholipid antibody syndrome
*clinical and laboratory criteria without
other recognized autoimmune disease
primary antiphospholipid syndrome
with other autoimmune disorders such as
SLE (systemic lupus erythematosus)
Secondary antiphospholipid syndrome
venous event
deep vein thrombosis of the lower
extremities
arterial event
stroke
risk factors of APAS
- autoimmune - lupus, sjogrens
- syphilis, HIV AIDS, lyme
- taking hydralazine, quinidine, phenytoin, and amoxicillin
- family Hx of APS
maternal implications:
___ prior to 34 weeks, and severe
___ requiring premature delivery
preeclampsia
fetal-newborn implications:
*Fetal ___
*___ for maternal severe
preeclampsia
- fetal growth restriction
- preterm delivery
fetal-newborn implications:
*____, a variety of systemic
and hematologic abnormalities, and isolated
congenital heart block
*Fetal deaths at or beyond ___ weeks gestation
neonatal lupus dermatitis; 20 wks
One or more clinical
episodes of arterial, venous, or small vessel thrombosis, occurring within any
tissue or organ
vascular thrombosis
assessment of APAS: laboratory criteria
- anticardiolipin antibodies
- lupus anticoagulant
complications:
*One or more unexplained ___of morphologically
normal fetuses at or after 10 weeks gestation
*One or more ___ of morphologically
normal fetuses at or before 34 weeks gestation
* Three or more unexplained consecutive ___ before 10 weeks gestation
- deaths
- premature births
- consecutive abortions
indication of thrombosis or stroke
possible residual neurologic findings
cutaneous manifestations of APAS
digital cyanosis, livedo reticularis, digital gangrene, leg ulcers, discoid rash, photosensitivity
*Laboratory criteria for the diagnosis of APS
- activated partial thromboplastin time (aPTT) - PROLONGED
- anticardiolipin antibody (aCL) or anti b2GPI - GREATER THAN 12-20 GPL UNITS
___ anticoagulant antibodies detected in blood on 2 or more occasions at least 6 weeks apart
lupus
___ antibodies -IgG or IgM in medium to-high levels, on 2 or more occasions at least 6 weeks apart
anticardiolipin
False-positive results from the ___ test
VRDL
true or false - All studies need to be repeated in at least 8 weeks for confirmation before the diagnosis of APS is appropriate
false - 6 weeks
Discuss the importance of planned pregnancies
so that long-term warfarin can be switched to
___ and ___ before pregnancy is
attempted
aspirin and heparin
- Complicated pregnancy: ___ every 3-4 weeks
starting at 18-20 weeks’ gestation
ultrasound
*Uncomplicated APS, UTZ at ___ weeks’ gestation to assess fetal growth
30-32
Stop the use of ___ and cytotoxic agents
chloroquine
Warfarin may be substituted for heparin during the postpartum period to limit further risk of heparin induced ___ and ___
osteoporosis and bone fracture
treatment for APS with prior fetal death or recurrent pregnancy loss
- heparin in prophylactic doses (15-20,000 U)
- calcium and vit D supplementation
treatment for APS with prior thrombosis or stroke
heparin to achieve full anticoagulation
treatment for APS without prior pregnancy loss or thrombosis
- no treatment OR
- low dose aspirin OR
- daily prophylactic heparin + low dose aspirin
treatment for AP with prior thrombosis or stroke in NONPREGNANT
warfarin
