Antiphospholipid syndrome (also known as Hughes Syndrome) causes ‘sticky blood’, where the blood becomes too thick to flow through the smaller blood vessels. It is also associated with thrombotic events, such as stroke, and pregnancy complications. During pregnancy, the blood is unable to reach and feed the placenta, causing miscarriage (commonly at around 10 weeks). Untreated, it may lead to insufficient fetal growth, pre-term delivery, pre-eclampsia, fetal loss or autoimmune thrombocytopenia.
Who is Likely to Suffer from Antiphospholipid Syndrome?
It is considered a ‘rare disease’ by the ORD (Office of Rare Diseases at the National Institute of Health) (1). Antiphospholipid syndrome is thought to affect fewer than 200,000 people in the US, where women account for approximately 80% of patients with APS. In the UK, around 40,000 women are believed to suffer from the condition (2).
People with other autoimmune diseases – such as Hashimoto's Disease – may suffer from APS, in which case it is known as ‘secondary antiphospholipid syndrome’. In someone with no other known form of autoimmune condition the APS is considered ‘primary antiphospholipid syndrome’.
What are the Risks of Antiphospholipid Syndrome?
Many people carry antiphospholipid antibodies without experiencing any problems at all. The risks are determined by the level of antibodies in the blood: higher levels indicate a higher risk of thrombotic events or complications. The risks to everyday health include headaches and migraines, giddiness, memory loss, skin disorders, visual disturbances, DVT (deep vein thrombosis), heart attack and stroke.
How Would I Know if I Have Antiphospholipid Syndrome?
The symptoms are many and varied, and can easily be misdiagnosed. Women often only find out that they have APS by suffering multiple pregnancy complications or a thrombotic event (such as stroke). Anyone suffering from three or more unexplained miscarriages should be tested for APS, though general health practitioners in most countries remain strangely unaware of this condition. Women are most commonly diagnosed as a result of suffering recurrent miscarriage or pre-term births.
Sometimes the disease results in a discoid rash (a raised rash with scaling), or photosensitivity (discomfort in bright light). Other rarer, associated conditions include unexplained events or conditions such as: digital cyanosis, digital gangrene, leg ulcers. livedo reticularis, transient ischemic attacks, haemolytic anemia, and chorea (a movement disorder).
Is There a Test for Antiphospholipid Syndrome?
Where antiphospholipid syndrome is suspected, two forms of blood test are used for diagnosis: the anticardiolipin test and the lupus anticoagulant test, both of which are available through hospitals. The tests are normally carried out twice, six weeks apart, to make sure that a positive result is not due to some transient event.
What is the Cause of Antiphospholipid Syndrome?
The cause is unknown, but certain autoimmune diseases are associated with antiphospholipid syndrome, and other factors can trigger an thrombotic event (such as a stroke), including smoking, immobility (on long-haul flights, for instance), and the contraceptive pill.
What are the Complications in Pregnancy?
The ‘sticky blood’ causes problems during the formation of the placenta, and may cause miscarriage (referred to by the medical profession as ‘spontaneous abortion’). Pre-eclampsia is another possible condition, the baby’s growth may be affected, and a pre-term birth (before 34 weeks) is possible. But all of these complications only occur in untreated women – with treatment, both mother and child can enjoy a healthy pregnancy.
Treatment for APS During Pregnancy
Women with antiphospholipid syndrome should be examined frequently during their pregnancy for evidence of thrombosis, preeclampsia, or any decrease of fetal movement. During the first trimester, levels of hCG (human chorionic gonadotropin) are measured to determine the ongoing safety of the pregnancy. (Levels should roughly double during the first month of pregnancy.) Ultrasound is generally carried out every 3–4 weeks from 18 weeks’ onward to check fetal growth, which can be adversely affected.
Treatment involves taking daily doses of ‘baby aspirin” (75mg), and daily injections of heparin, an anticoagulant drug, which the pregnancy woman can administer herself. Since heparin can occasionally (1–2% of cases) induce osteoporosis, a bone-density scan is often offered once the woman is no longer pregnant.
Note that no one should start taking even low-dose aspirin regularly unless recommended to do so by a physician, as it can lead to bleeding.
Is Any Post-pregnancy Treatment Necessary?
Anyone who has been diagnosed with antiphospholipid syndrome should be evaluated for renal disease, (glomerulonephritis, end-stage renal disease), anemia, and thrombocytopenia. Where the condition is secondary to another autoimmune disease, immunosuppressive agents may be appropriate.
Read More: Becoming a Mother with Hashimoto's Disease
Notes
- Antiphospholipid Syndrome from NIH
- Arthritis Research Campaign, UK, Press Release May 2002.
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