Antiphospholipid Syndrome (cont.)
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.
Next: What is catastrophic antiphospholipid syndrome? »
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