Antiphospholipid syndrome (APS) is the name given to a condition in which two criteria have to be fulfilled:
1. The presence of a specific group of antibodies against phospholipids. This antibody may be detected by a blood test.
2. The presence of certain clinical problems including one of the following:
Loss of a baby after the first trimester (13 weeks)
Pre-eclampsia (hypertensive disease in pregnancy)
Unexpectedly small babies
Thombosis in a vein or artery
Do I have antiphospholipid syndrome?
If you have one of the clinical problems described above but do not have detectable antibodies, you do not have the condition. On the other hand, if you test positive for the antibody, but do not have any one of the clinical problems described above, you also do not have the condition.
In addition, in some individuals, the antibodies may be present for a very short while and then disappear. If you test positive for the antibody, it ought to be repeated. The result is significant only if you persistently test positive for the antibodies.
Pregnancy and APS
One of the most common and distressing problems with APS is that of recurrent pregnancy loss. However, effective treatment is available. The treatment may consist of:
Low dose aspirin (75 mg per day) starting in early pregnancy, often as soon as the pregnancy test is positive, although in some cases it might be started after the detection of heart beats by ultrasound, around 7 weeks or so.
Clexane, which is given by injection once a day. The dose may be 20 mg or 40 mg.
Sometimes treatment consists of a combination of low dose aspirin and Clexane injection.
In addition, women who have APS ought to be monitored closely during pregnancy, not only in the first trimester, but also subsequently to ensure that the baby is growing satisfactorily.
Thrombosis and APS
A thrombosis is a blood clot which forms when it shouldn’t do, such as in a deep vein of the leg (DVT) or in an artery. Clots from the leg can dislodge and move to more dangerous places such as the lung (pulmonary embolism).
APS can make someone more likely to get thrombosis, but there are times when this is particularly important and thrombosis is already a risk, for example after major surgery, during prolonged illness or bed rest, during pregnancy and for a short time after delivery. During these times, preventive measures against clot formation are needed. These include tight medical stockings or clexane/heparin treatment. In more severe cases of thrombosis, it may mean long-term treatment with tablets to thin the blood. Women with APS shouldn’t take the combined (oestrogen-containing) contraceptive pill.
How common is APS?
The antibodies are present in about 2-3% of women. Not all of them will have clinical problems described above, so they do not necessarily have the disease.
What else should I do?
If you are pregnant your obstetrician will monitor your pregnancy closely. If you smoke, you ought to stop because smoking increases the likelihood of problems occurring in pregnancy as well as the risk of thrombosis.
Prof T C Li
7 Williamson Road
Tel: 0114 2550365