ANTIPHOSPHOLIPID SYNDROME

History 1. Ask about venous thromboses- DVTs, pelvic veins, PEs 2. Ask about arterial thromboses- AMI, CVA 3. Ask about hx of recurrent miscarriages in first trimester or later abortion 4. Ask about bleeding problems- thrombocytopenia, livedo reticularis, CNS complications such as migraine, eclampsia or pre-eclampsia with HELLP syndrome: Haemolysis, Elevated Liver enzymes and Low Platelets 5. Ask about associated disorder such as SLE Clinical manifestations of Antiphospholipid syndrome 1. Cardiac- AMI, valvular heart disease, pulmonary hypertension 2. Haematological- haemolytic anaemia, thrombocytopenia, migraine 3. Renal- renal vein thrombosis 4. Endocrine- Addisons disease 5. Neurological- CVA 6. Gastrointestinal- bowel ischaemia 7. Obstetric- recurrent miscarriages 8. Dermatological- livedo reticularis, ulcers Examination 1. Look for signs associated with autoimmune disease- skin rashes and joint abnormalities in SLE, dry eyes ass/ w/ Sjogrens syndrome 2. Livedo reticularis 3. Heart murmurs from sterile valve vegetations Investigations IgG anticardiolipin antibodies Antibodies to beta-2 glycoprotein Lupus inhibitor Check for other thrombophilia screening- Factor V Leiden, protein C and S deficiency, Anti-thrombin 3 deficiency, APC gene mutation ANA, ENA FBC- platelets V/Q scan, CTPA, venous duplex Diagnosis At least 1 clinical AND 1 lab criteria Vascular thrombosis- superficial venous thrombosis DO NOT satisfy Pregnancy morbidity (unexplained fetal death >10 weeks, premature births <34weeks due to eclampsia, preeclampsia or unexplained >3 pregnancy of <10 week gestation losses) Presence of aPL on >2 occasions at least 23 weeks apart o IgG and/or IgM aCL o Antibodies to beta2-glycoprotein o Lupus anticoagulant Treatment Life-long anticoagulation Women with previous recurrent abortions will require treatment during pregnancy. LMWH with aspirin can be used during pregnancy. Warfarin is contraindicated in pregnancy