Antiphospholipid Antibodies and Antiphospholipid Syndrome

Antiphospholipid Antibodies is a disorder of coagulation, and causes thrombosis in both arteries and veins, as well as recurrent miscarriage. That is characterized by excessive clotting of blood and/or certain complications of pregnancy (premature miscarriages, unexplained fetal death, or premature birth ) and the presence of antiphospholipid antibodies (cardiolipin or lupus anticoagulant antibodies) in the blood. Antiphospholipid syndrome is also called the phospholipid antibody syndrome. Antiphospholipid antibodies (APA) are proteins naturally produced by your body but that mistake your cells for invaders. Patients with antiphospholipid syndrome have developed abnormal symptoms while having antiphospholipid antibodies that are detectable with blood testing.

Traditionally, antiphospholipid antibodies (APLs) have been classified based on the three types of clinical laboratory assays used to detect them. First, APLs may give false-positive reactions in nontreponemal screening tests for syphilis. Tests such as the VDRL and RPR are flocculation assays in which the anionic phospholipid cardiolipin is a constituent of the antigenic mixture. Second, antibodies that are detected by their ability to prolong certain in vitro phospholipid-dependent coagulation reactions (e.g., the conversion of prothrombin to thrombin) are termed lupus anticoagulants. Third, anticardiolipin antibodies are detected in enzyme-linked immunosorbent assays (ELISAs), in which cardiolipin is immobilized on microtiter plates.

Antiphospholipid syndrome is also known as antiphospholipid antibody syndrom which arises due to the autoimmune production of antibodies against cell membrane constituents. Nevertheless, the antiphospholipid antibody (a protein) is not considered a normal blood protein and has been found in patients to be associated with a number of illnesses. It is very rare form is the catastrophic antiphospholipid syndrome, in which there is rapid organ dysfunction and failure. It carries a high mortality. Antiphospholipid syndrome has been referred to as Hughes syndrome in honor of the doctor who first described it. Antibodies are produced by the body's immune system to fight infection from bacteria and viruses. About a third of patients with primary APLS have heart valve abnormalities. In some diseases, the immune system produces antibodies that mistakenly attack the body's own tissues. Some are effect Patients with secondary antiphospholipid syndrome may report symptoms of the underlying disease. For example, patients with underlying systemic lupus erythematosus may report features including a rash on the cheeks, skin reaction to sunlight, joint pains, mouth ulcers, excessive hair loss, dry eyes, cold and bluish fingers, and sometimes sharp chest pains.

Prevalence of Antiphospholipid Antibodies and Antiphospholipid Syndrome

In cross-sectional studies, the prevalence of anticardiolipin antibodies in patients with SLE ranges from approximately 17% to 39%). Lupus anticoagulants are present in 11% to 30%. Clinical manifestations of APS probably affect 30% to 50% of patients with these antibodies or roughly 10% to 20% of patients with SLE. The prevalence of the primary APS is unknown. Retrospective studies of have identified APL in 5% to 30% of patients without SLE with a history of thrombosis.

Causes of Antiphospholipid Antibodies and Antiphospholipid Syndrome

Some common causes of Antiphospholipid Antibodies and Antiphospholipid Syndrome are:

• APS is an autoimmune disorder of unknown cause. The search for possible triggers has uncovered a wide array of associated autoimmune or rheumatic diseases, infections, and drugs that are associated with the LA or aCL antibodies.
• The main problem is regurgitation -- blood leaking backward through the valves.
• The mitral valve is most often affected, followed by the aortic valve.
• Familial association: Relatives of persons with known APS are more likely to have aPL antibodies. One study showed a 33% incidence rate.

Treatment of antiphospholipid syndrome

• Some are importent treatment follows
• The main aim of treatment is to 'thin' the blood, so that this tendency is reduced. This is usually achieved with a tablet called warfarin (eg Marevan) , which is an anticoagulant (literally anti-clotting). This is taken daily, and regular blood tests are required to ensure that the warfarin is thinning the blood to the required degree.
• The antiphospholipid syndrome is treated by giving aspirin to inhibit platelet activation, and/or warfarin as an anticoagulant .
• The goal of the prophylactic treatment is to maintain the patient's INR between 2.0-3.0. It is not usually done in patients who have not had any thrombotic symptoms. During pregnancy , heparin is used instead of warfarin because of warfarin's teratogenicity .
• At present the recommended treatment is low dose aspirin, providing there are no contraindications.

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