Review diagnosis and management of antiphospholipid syndrome in pregnancy authors bethan myers sue pavord key content. Salmon3 introduction the antiphospholipid syndrome aps is an autoimmune condition associated with thrombosis venous or arterial and adverse pregnancy outcomes. The diagnosis of antiphospholipid syndrome is predominantly made in the laboratory and depends on the persistent presence of antiphospholipid antibodies in individuals with thrombosis or pregnancy morbidity. The diagnosis of antiphospholipid syndrome aps requires both characteristic clinical features and persistentl y abnormal laboratory tests. Antiphospholipid antibody syndrome aps during pregnancy may result in pregnancy morbidity and passive transfer of antibodies to the fetus, resulting in an increased risk of prematurity, intrauterine growth restriction, thrombocytopenia, and developmental delay. Management of antiphospholipid syndrome in pregnancy saegre.
Diagnosis and management of the antiphospholipid syndrome. College of chest physicians evidencebased clinical practice guidelines. Antiphospholipid syndrome and pregnancy pathogenesis to translation vikki m. The objective was to develop evidencebased recommendations for the management of antiphospholipid syndrome aps in adults. Antiphospholipid syndrome in pregnancy royal college of. B antiphospholipid antibody aplmediated endothelial nitric oxide synthase enos inhibition, impaired nitric oxide no production and release, and endothelial. Investigation of aps began with the discovery of auto. Aps occurs when your bodys immune system makes antibodies that attack phospholipids. Antiphospholipid antibody syndrome national heart, lung. The incidence and prevalence of antiphospholipid syndrome are estimated at. Pdf on apr 20, 2012, kjell haram and others published antiphospholipid syndrome.
Highrisk antiphospholipid antibody apl profile is associated with. Antiphospholipid syndrome genetics home reference nih. Signs and symptoms vary, but may include blood clots, miscarriage, rash, chronic headaches, dementia, and seizures. Antiphospholipid syndrome is a disorder characterized by an increased tendency to form abnormal blood clots thromboses that can block blood vessels. Management of antiphospholipid syndrome annals of the. Antiphospholipid syndrome aps is an autoimmune thrombophilic condition that is marked by the presence in blood of antibodies that recognize and attack phospholipidbinding proteins, rather than phospholipid itself. The antiphospholipid syndrome is a disorder of the immune system that is characterized by excessive clotting of blood andor certain complications of pregnancy premature miscarriages, unexplained fetal death, or premature birth and the presence of antiphospholipid antibodies such as anticardiolipin or lupus anticoagulant antibodies in the blood. What you need to know about ovarian hyperstimulation syndrome ohss implantation. Medicine can help reduce your risk for blood clots, but they can still happen. Prepregnancy assessment and counselling play an important part in optimising. Investigation and management of antiphospholipid syndrome. Antiphospholipid syndrome aps is an autoimmune disease characterised by the presence of antiphospholipid antibodies apl. An update on the management of antiphospholipid syndrome. Gp1 receptors on endothelial cells following a second hit in.
Antiphospholipid syndrome aps is a systemic autoimmune disorder characterized by recurrent venous or arterial thrombosis with or without pregnancy morbidity in the presence of persistent antiphospholipid apl autoantibodies. Antiphospholipid syndrome was described in full in the 1980s, aftervarious previous reports of specificantibodies in people with systemic lupus hugheserythematosus and thrombosis. Antiphospholipid syndrome is an autoimmune systemic disorder characterized by arterial, venous, or small vessel thrombosis andor recurrent early pregnancy loss, fetal loss, or pregnancy morbidity in the setting of documented persistent antiphospholipid antibodies that include the lupus anticoagulant, or moderatehigh titer anticardiolipin, or anti. The many recent changes in concept regarding this syndrome, the role of the relevant antibodies, mechanism of action, diagnosis and treatment are assessed in this. B antiphospholipid antibody apl mediated endothelial nitric oxide synthase enos inhibition, impaired nitric oxide no production and release, and endothelial dysfunction. The antiphospholipid syndrome aps is characterized clinically by the occurrence of either venous or arterial thrombosis in diverse vascular beds, or recurrent miscarriages in the first trimester, or fetal death in the second or third trimesters, or severe preeclampsia necessitating delivery of a premature infant before 34 weeks of gestation. Key points about antiphospholipid syndrome in pregnancy. Treatment of antiphospholipid antibody syndrome antiphospholipid antibody syndrome aps is a systemic autoimmune disease with thrombotic predilection resulting in vascular thrombotic events and obstetric complications.
This primer provides an update on the epidemiology. What are the guidelines for antiphospholipid syndrome aps. The clinical manifestations of aps include vascular thrombosis and pregnancy complications, especially recurrent spontaneous miscarriages. As part of your treatment youll be prescribed anticoagulant medicine such as warfarin, or an antiplatelet medication such as lowdose aspirin these work by interrupting the process of blood clot formation.
The present clinical and laboratory classification criteria for antiphospholipid syndrome aps were established in sydney, australia, in 2006. If you have this condition in pregnancy, your healthcare provider will watch you closely. Antiphospholipid syndrome is an autoimmune disease associated with a variety of symptoms, including thrombosis and obstetrical complications. Inthisleaflet,wellassume thatyouhavehadrepeated miscarriages,havebeendiagnosedwith. Recognizing miscarriage as a loss is an important part of the healing process. Antiphospholipid syndrome is an autoimmune disease. Correct diagnosis of the syndrome is imperative to prevent unnecessary long secondary thromboprophylaxis. Anticardiolipin antibodies of igg andor igm isotype in serum or plasma. One or more clinical episodes of arterial, venous or small vessel thrombosis 2. In addition, family members of patients with aps appear to have an increased risk for.
Antiphospholipid syndrome antiphospholipid syndrome aps is a systemic autoimmune disorder characterized by venous or arterial thrombosis andor pregnancy morbidity in the presence of persistent laboratory evidence of antiphospholipid antibodies apl 1. Antiphospholipid antibodies are a heterogeneous group of autoantibodies that are detected by immunoassays and functional coagulation tests. The antiphospholipid syndrome aps is an autoimmune condition associated with thrombosis venous or arterial and adverse pregnancy outcomes. Antiphospholipid syndrome aps is a systemic autoimmune disorder characterized by venous or arterial thrombosis andor pregnancy loss in the presence of persistent antiphospholipid antibodies apl. Good management in an expert setting can result in a live birth rate of 80%. Antiphospholipid syndrome, also known as hughes syndrome, is an autoimmune disease characterised by a set of clinical manifestations, almost all of which are direct or indirect sequelae of a hypercoagulable state involving the venous, and to a lesser extent the arterial vasculature. Guidelines recommend treatment with injectable blood thinners. Antiphospholipid syndrome aps has also been reported to cluster in families, and family members of patients with aps have an increased risk for having evidence for antiphospholipid antibodies when tested. Antiphospholipid antibody syndrome is one of the most important ac quired causes of hypercoagulability and pregnancy loss 1. Read more about decoding the role men play in pregnancy. Antiphospholipid antibody syndrome commonly called antiphospholipid syndrome or aps is an autoimmune disease present mostly in young women.
Antiphospholipid syndrome aps is a systemic autoimmune disorder. They note that a highrisk antiphospholipid antibody apl profile is associated with greater risk for thrombotic and obstetric aps. Treatment for antiphospholipid syndrome aps aims to reduce your risk of developing more blood clots. It includes a section on who should be tested for apl antibodies and. Recurrent pregnancy loss with antiphospholipid antibody. Aps occurs as a primary condition, or it can occur in the presence of systemic. Predisposes to arterial and microvascular thrombosis, as well as venous thromboembolism, and can affect any vessel in the body.
Neonatal antiphospholipid syndrome american academy of. Antiphospholipid syndrome aps is an autoimmune disorder. This causes blood to flow improperly and can lead to dangerous clotting in arteries and veins, problems for a. Antiphospholipid antibody syndrome is an autoimmune disorder in which the bodys immune system makes antibodies that attack phospholipids, causing cell damage and blood clots. Antiphospholipid syndrome genetic and rare diseases. The latter antibodies are frequently associated with thrombosis, fetal loss and other clinical. Thefirstthingtoknowisthat antiphospholipidsyndromeisalso called antiphospholipidantibody syndromeor. Antiphospholipid syndrome antiphospholipidantibody positivity should be included in the differential diagnosis if a patient presents with thrombosis at a young age, with the new england journal of medicine downloaded from by e. Aps provokes blood clots in both arteries and veins as well as pregnancyrelated complications such as miscarriage, stillbirth, preterm delivery, and severe preeclampsia. In antiphospholipid syndrome, the thromboses can develop in nearly any blood vessel in the body, but most frequently occur in the vessels of the lower limbs. Antiphospholipid syndrome aps is an autoimmune disease char acterized by persistently elevated titres of antiphospholipid anti bodies apls that predispose individuals to arterial andor venous thrombosis or to pregnancy complications 1,2. Learn more about causes, risk factors, signs and symptoms, complications, diagnoses, treatments, and how to participate in clinical trials. Antiphospholipid syndrome, noncriteria antiphospholipid antibodies, antiphosphatidylserine prothrombin antibodies, anti.
Antiphospholipid syndrome aps is an autoimmune disorder characterised by arterial and venous thrombosis, adverse pregnancy outcomes for mother and fetus, and raised levels of antiphospholipid apl antibodies. Antiphospholipid syndrome aps is an autoimmune disorder that is associated with pregnancy complications, including preeclampsia, thrombosis, autoimmune thrombocytopenia, fetal growth restriction, and fetal loss. Diagnosis and management of antiphospholipid syndrome in. C aplmediated endothelial cell proliferation, intimal hyperplasia, and nonatherosclerotic vascular stenosis. Sciascia s, murru v, sanna g, roccatello d, khamashta ma, bertolaccini ml. Those with aps make abnormal proteins called antiphospholipid autoantibodies in the blood. Antiphospholipid antibodies in pregnancy are associated with recurrent. The syndrome is sometimes referred to as hughes syndrome,after the rheumatologist dr. Review diagnosis and management of antiphospholipid.
Aps is classified as primary or secondary, depending on its association with other autoimmune. Presence of antiphospholipid antibody apl alone, in the absence of typical clinical complications. Antiphospholipid syndrome can cause serious morbidity in mother and fetus. The promisse study predictors of pregnancy outcome.
Phospholipids are a type of fat found in all living cells, including blood cells and. Criteria for defining the antiphospholipid antibody syndrome clinical criteria 1. Pdf on apr 20, 2012, kjell haram and others published antiphospholipid syndrome in pregnancy find, read and cite all the research you need on researchgate. Antiphospholipid syndrome aps, sometimes known as hughes syndrome, is a disorder of the immune system that causes an increased risk of blood clots. Noncriteria antiphospholipid antibodies add value to.
Anti phospholipid antibody ppt linkedin slideshare. Antiphospholipid syndrome treatment algorithm bmj best. Clinical accuracy for diagnosis of antiphospholipid syndrome in systemic lupus erythematosus. Antiphospholipid syndrome, or antiphospholipid antibody syndrome aps or apls, is an autoimmune, hypercoagulable state caused by antiphospholipid antibodies. Prophylaxis during pregnancy is provided with subcutaneous heparin preferably lowmolecularweight heparin lmwh and lowdose aspirin.