Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Kaye received a Bachelor of Arts degree with honors from the University of California, San Diego in Applied Mechanics and Engineering Sciences. After graduating from New York Medical College, he completed his internship and residency training in pathology at Harbor - UCLA Medical Center.
What laboratory tests can support the diagnosis
of antiphospholipid syndrome?
Patients with the antiphospholipid syndrome can have a
variety of antibodies to molecules called phospholipids in their blood. These antibodies include
VDRL/RPR (a syphilis test that can
be falsely positive in these patients), lupus anticoagulant, prolonged PTT, and
cardiolipin antibody. As mentioned above, the anticardiolipin antibody has also
been found in patients with the immune disease systemic lupus erythematosus, which is characterized by the production of a variety of abnormal antibodies.
What causes antiphospholipid syndrome?
The cause of antiphospholipid syndrome is not completely known. Antiphospholipid antibodies
reduce the levels of annexin V, a protein that binds phospholipids
and has potent clot-blocking (anticoagulant) activity. The reduction of annexin V
levels is thought to be a possible mechanism underlying the increased
tendency
of blood to clot and the propensity to pregnancy loss characteristic
of the antiphospholipid syndrome.
Antiphospholipid antibodies, such as anticardiolipin, have also been associated with decreased levels of prostacyclin, a chemical that prevents the clumping together of normal blood clotting elements called platelets.
How is antiphospholipid syndrome treated?
The treatment of patients with
anticardiolipin syndrome has substantially evolved since they were discovered to
be clinically important in the mid-1980s. Each manifestation of the
antiphospholipid syndrome, and each individual patient with the condition, is treated uniquely.
Because many of the features of illness with
anticardiolipin syndrome are associated with an abnormal grouping of normal
blood clotting elements (platelets), treatment is often directed toward
preventing clotting by thinning the blood. Patients with this disorder have an
abnormal tendency to form blood clots (thrombosis). The abnormal blood clotting
can affect the function of virtually any organ. Medications that thin
(anticoagulate) the blood, such as heparin (Hep-Lock, Liquaemin) and warfarin (Coumadin) (powerful blood
thinners), are used for treatment. Aspirin has an affect on platelets that
inhibits their grouping (aggregation) and has also been used in low doses to
thin the blood of selected patients. Cortisone-related medications, such as
prednisone, have been used to suppress the immune activity and inflammation in
patients with certain features of the condition. For patients with systemic
lupus erythematosus who also have antiphospholipid syndrome, hydroxychloroquine
(Plaquenil) has been reported to add some protection against blood clotting.
Other reported treatments include the use of intravenous
gamma globulin for selected patients with
histories of premature miscarriage and those with low blood-clotting
elements (platelets) during pregnancy. Recent research studies, however, suggest that intravenous gamma globulin may be no more effective than combination aspirin and heparin treatment.
Migraine is usually periodic attacks of headaches on one or both sides of the head. These may be accompanied by nausea, vomiting, increased sensitivity of the eyes to light (photophobia), increased sensitivity to sound (phonophobia), dizziness, blurred vision, cognitive disturbances, and other symptoms. Treatments for migraine headache include therapies that may or may not involve medications.
Deep vein thrombosis (DVT) is a blood clot in a vein located deep in the muscles of the legs, thighs, pelvis (lower torso), or arms. The most common symptoms of a deep vein thrombosis are swelling and pain in the leg that has the blood clot. A DVT is difficult to diagnose without specific tests in which the deep vein system can be examined.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
A miscarriage is any pregnancy that ends spontaneously before the fetus can survive. Miscarriage usually occurs before the 13th week of pregnancy. The cause of a miscarriage cannot always be determined. The most common causes of a miscarriage in the first trimester are collagen vascular disease (lupus), hormonal problems, diabetes, chromosomal abnormalities, and congenital abnormalities of the uterus.
Pregnancy planning is important to help prevent exposure of the mother and fetus to potentially harmful medications and substances during the early days, and throughout the pregnancy. Nutritional planning, prevention of birth defects, conditions such as high blood pressure, heart disease, diabetes, and kidney disease need careful monitoring. Gestational diabetes, preeclampsia, and pregnancy induced hypertension are conditions that may arise during pregnancy. Immunizations, inherited disorders, exercise, air travel, intercourse, and birth control are important factors to consider when planning a pregnancy.
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