Anti-Phospholipid Antibody Syndrome
Anti-phospholipid antibody syndrome (APLAS) is an autoimmune disease that causes the body to mount an attack against itself.
The immune systems of people with Anti-phospholipid antibody syndrome produce antibodies called anti-phospholipid antibodies. These antibodies can cause vascular (blood flow) problems including blood clots in arteries and veins. They can also cause pregnancy complications such as repeated miscarriages.
There are two types of Anti-phospholipid antibody syndrome:
- Primary occurs in the absence of any other disease.
- Secondary is linked to other autoimmune diseases such as lupus (systemic lupus erythematosus).
Anti-phospholipid antibody syndrome can be a very serious disease and it can be life-threatening without treatment.
Once anti-phospholipid antibody syndrome is correctly diagnosed, treatment can be very effective.
Understanding Anti-Phospholipid Antibody Syndrome
Anti-phospholipid antibody syndrome is a poorly understood disease. There are many different symptoms that can be associated with anti-phospholipid antibody syndrome. It can strike otherwise healthy people and they often don’t know they have the disease until they have a medical incident.
If you have anti-phospholipid antibody syndrome or think you may have it, consult your family doctor for a referral to a specialist.
Symptoms Affecting Pregnancy
In pregnant women, anti-phospholipid antibody syndrome can cause the placenta to form improperly. This can result in pregnancy loss during the first trimester. This can happen multiple times.
As a general rule, three pregnancy losses in the first trimester, a pregnancy loss after the first trimester, and a premature birth (prior to 34 weeks) could all be the result of anti-phospholipid antibodies.
Blood Clots
Anti-phospholipid antibody syndrome can cause blood clots in the veins. Deep vein thrombosis (DVT) can occur if the clot occurs in the deep veins of the leg. Part of this clot can break free and float into the lung where it can cause a pulmonary embolism (PE). The symptoms of a pulmonary embolism can include chest pain and shortness of breath.
Anti-phospholipid antibody syndrome can also cause blood clots in the arteries. If an artery supplying the brain is affected then a stroke is possible. A stroke occurs when a blood clot prevents blood from getting to the brain. “Mini strokes” called transient ischemic attacks (TIA) can also occur.
Any artery in the body can potentially become affected including those supplying the lungs, kidneys, bones, bowels and heart. Fortunately this is rare.
Other Symptoms
Other symptoms of anti-phospholipid antibody syndrome include Raynaud’s phenomenon (fingers turning white in the cold) and migraine headaches.
Some people with anti-phospholipid antibody syndrome have a mottled or blotchy appearance to the skin that can get worse in the cold.
Anti-phospholipid antibody syndrome can also be associated with other neurologic problems including hearing loss, seizures, psychosis, and chorea (abnormal movements).
Some people with anti-phospholipid antibody syndrome may have a low platelet count or anemia.
Anti-phospholipid antibody syndrome can sometimes be difficult to diagnose. In many cases its symptoms are not apparent until serious medical incidents occur such as repeated miscarriages, blood clots, or events that occur as a result of blood clots such as a pulmonary embolism or stroke.
A rheumatologist (a specialist in arthritis and autoimmune diseases) or a haematologist (a specialist in blood disorders) may be required to diagnose the disease.
History and Physical Examination
Your doctor will take a complete history and perform a thorough physical examination. This is usually followed by blood tests.
Blood Tests
There are two blood tests that can help diagnose anti-phospholipid antibody syndrome: the lupus anticoagulant and anti-cardiolipin antibody tests. These tests should be done twice at least twelve (12) weeks apart to confirm the persistent presence of these antibodies.
Other blood tests that may be ordered include:
- Complete Blood Count (CBC)
- Creatinine and Urinalysis
- ESR and CRP
- Anti-Nuclear Antibody (ANA) test
- Anti-Double Stranded DNA (anti-dsDNA)
- Extractable Nuclear Antigen (ENA) Panel
- Rheumatoid Factor
No one knows why people develop anti-phospholipid antibodies. For an unknown reason, the immune system decides to mount an attack against the body.
Anti-phospholipid antibody syndrome can be a serious disease. While there is no cure for anti-phospholipid antibody syndrome, it is treatable. Many people respond well to treatment.
People with anti-phospholipid antibody syndrome usually see a hematologist (a specialist in blood disorders) and a rheumatologist if they have a secondary autoimmune condition underlying the anti-phospholipid antibody syndrome.
If you are diagnosed with anti-phospholipid antibody syndrome, we recommend that you:
- Learn as much as you can about this disease
- Attend your medical appointments regularly
- Get your blood tests done as suggested by your rheumatologist and/or hematologist
- Learn about the medications used to treat anti-phospholipid antibody syndrome.
People with anti-phospholipid antibody syndrome can lead active and productive lives with the right kinds of treatment. The medications available today are very effective and can help get you back to leading a full life.
Medications for Anti-Phospholipid Antibody Syndrome
There are three main medications used to treat anti-phospholipid antibody syndrome: heparin, warfarin and aspirin. Every treatment plan is unique and tailored to individual symptoms.
For an acute (fast onset) blood clotting event such as a stroke or deep venous thrombosis, you will first be treated with a blood thinner called heparin. This will be given by an intravenous infusion or a daily injection. Once you have stabilized, you will be switched to another blood thinning medication called warfarin (Coumadin). You may also be given aspirin if you are at high risk of other events. These medications may be given in combination.
Other blood thinners known as direct oral anticoagulants are sometimes considered in place of warfarin because they are more convenient, don’t need monitoring, and have less risk of bleeding. The issue is these anticoagulants are considered less effective than warfarin especially in high-risk patients.
Treatment in Pregnancy
Treatment during pregnancy can be more complicated. For women with recurrent miscarriages, pregnancy can be successful in some cases with appropriate therapy.
Aspirin can be used early in pregnancy, and may be sufficient treatment on its own. Warfarin can’t be taken during pregnancy. Pregnant women who need more than aspirin can also be given heparin.
Birth Control Warning
Women with anti-phospholipid antibody syndrome should avoid taking estrogen containing oral birth control pills because they can potentially increase the risk of blood clotting.