Friday, April 18, 2014

Anticardiolipin Syndrome

Definition

The antiphospholipid (anticardiolipin) syndrome (APS) is characterized by recurrent venous or arterial thrombosis (clots), recurrent fetal loss, and thrombocytopenia (a reduction in the number of platelets).

Antiphospholipid antibody syndrome can be either primary or secondary to other diseases such as lupus.

Description

Antiphospholipid antibody (aPL) is an antibody that reacts with negatively charged phospholipids, molecules which are common constituents of cell membranes.

Two primary aPLs are lupus anticoagulant and anticardiolipin antibody. Although the term 'anticoagulant' would imply a tendency for bleeding (anti (against) + coagulant (clotting)), in fact, these antibodies tend to increase clot formation. Such antibodies are often found in association with pathological conditions, including thrombosis (clotting), fetal loss, and thrombocytopenia (low platelets). However, such antibodies are also found in some individuals with no apparent ill effects, so that the role of these antibodies remains unclear.

The primary consequence of the antiphospholipid antibody is non-inflammatory thromboembolic (clotting) disease. Virtually all venous and arterial systems have been cited, including large, medium, and small vessels.

The most common site for venous thrombosis is in the leg, in the femoral and popliteal (the posterior region of the knee) systems, whereas cerebral ischemia (low blood blow to the brain), manifested as embolic strokes and transient ischemic attacks (TIAs), is the most commonly reported arterial presentation.

Anticardiolipin Antibodies and Pregnancy.

Pregnant patients who have anticardiolipin antibodies are at increased risk for miscarriage, fetal growth retardation and stillbirth.

Anticardiolipin Antibodies and Heart Attacks (Myocardial Infarction).

The presence of lupus anticoagulants and anticardiolipin antibodies (aCL) has been associated with young victims of myocardial infarction (heart attack).

Causes

Some patients may have a positive family history of recurrent clotting or fetal loss.

Diagnosis

After a complete medical history including your family history and a physical examination, your physician will order blood tests that can detect antiphospholipid antibodies, including lupus anticoagulant and anticardiolipin antibodies.

Treatment

Treatment varies by patient and includes management of the underlying cause (e.g., lupus), if present. In some cases, treatment may include medications that promote anticoagulation (impair clotting). Patients taking anti-coagulants need to be monitored closely given the increased risks for bleeding.

Questions

What are anticardiolipin antibodies?

How can these antibodies be detected?

Which parts of the body are affected?

How is it associated with lupus?

What treatments are available?

What are the risks?