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Antiphospholipid Antibody Syndrome
Written By: Michele R. Lauria, MD, MS
Division of Maternal-Fetal Medicine
Dartmouth Hitchcock Medicine Center, Lebanon, NH
Antiphospholipid antibody syndrome (APS) is an
illness that involve the immune system, and causes increased clotting of the
blood. Normally antibodies, chemicals made by the immune system, are helpful
in fighting germs or viral infections from outside the body. However in APS,
the immune system makes antibodies that cause blood to clot abnormally. This
may cause problems with the pregnancy.
The diagnosis of APS is
very difficult, and also controversial among doctors.
There are 3 blood tests
that are commonly used, and accepted by most physicians.
As many as 15 blood
tests for antiphospholipids are available; however, there is little evidence
that patients who are positive by the "extra" blood tests are at increased
risk for pregnancy problems.
The problem is that 2%
of all pregnant women have positive blood tests. Most of these women never
have problems with abnormal pregnancy outcomes and treating them would expose
them to the side effects of the treatment without benefit.
Therefore, diagnosis
involves more than blood tests.
There must be "clinical
signs" medical problems that have already occurred in addition to the abnormal
blood tests.
The clinical signs are
a history of blood clots in a large vein or in an artery, three or more
consecutive miscarriages, low platelet count, anemia caused by blood being
broken down in the blood stream, stroke, and still birth.
The levels of antibody
can go up and down, and even disappear, so to definitely say someone has APS,
the blood tests need to repeated at least 8 weeks from the first and still be
positive. The decision on treatment at a particular time (such as pregnancy)
depends upon the levels and what the previous medical problems were.
Patients with APS are more prone to blood clots
during pregnancy and up to 6 weeks after pregnancy. The blood clots may
migrate to the lungs which is a very serious and life threatening event.
Ideally, one should
seek medical advice before becoming pregnant. When you get pregnant it is
important to be referred to your Obstetrician as early as possible to decide
on the need for treatment with aspirin or heparin.
Once pregnancy is
achieved, frequent office visits will be needed to:
Screen for
preeclampsia,
Monitor the fetus with
either nonstress test or biophysical profile
Ultrasound examinations
every 3-4 weeks to check the growth of the baby.
For patients on
heparin, extra blood tests may be needed to adjust the dose depending on the
type of heparin being used, and the past history of the patient.
Patients on low
molecular weight heparin may not be able to have epidural or spinal
anesthesia.
Treatment of APS during
pregnancy involves low dose aspirin and/or heparin
1 baby aspirin (80
mg)/day is usually started as soon as pregnancy is diagnosed
Heparin injections are
usually started at 8 weeks. Not all patients with APS need heparin.
Heparin is a blood
thinner. It can only be given by injection. The needle is very thin, and is
put just under the skin. Most patients can do this by themselves.
The effects of heparin
depend on the dose given
In "therapeutic
doses" the blood does not clot, and women will bruise and bleed easily.
In "prophylactic
doses", the blood clots normally and there is just bruising at the site of
injection.
The dose used depends on the clinical problems from APS.
There are 2 types of heparin
Low
molecular weight heparin
Is
given once or twice a day.
It
is almost 10 times as expensive as regular heparin.
It
lasts longer than regular heparin so epidural anesthesia cannot be used
unless 24 hours has elapsed since the last injection.
Unfractionated or regular heparin
It
is given 2 – 3 times a day.
It
costs much less than low molecular weight heparin.
It
has a higher chance of causing low platelets as a side effect than does low
molecular weight heparin.
If
only "prophylactic" doses are used, there is no problem with epidural
anesthesia.
The APS Foundation of America, Inc. website
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DISCLAIMER: APS Foundation of America,
Inc. website is not intended to replace standard doctor-patient visits, physical
examination, and medical testing. Information given to members is
only an opinion. All information should be confirmed with your personal doctor.
Always seek the advice of a trained physician in person before seeking any new
treatment regarding your medical diagnosis or condition. Any information
received from APS Foundation of America, Inc. website is not intended
to diagnose, treat, or cure. This site is for informational purposes only.
If you think you may have a medical emergency, call your doctor or 911
immediately.
