FAQs
1. What is meant by antiphospholipid syndrome (APS)?
It is a condition when your immune system mistakenly produces antibodies that attack phospholipids and make your blood much more likely to clot in blood vessels.
2. What are phospholipids and where are they found in our body?
Phospholipids are a type of fat or lipids which occur naturally in all living organisms as the major components of cell membranes including cells lining blood vessels. There are many types of phospholipids.
3. What problems do antiphospholipid antibodies produce in the body?
Antiphospholipid antibodies increase the risk of excessive blood clotting arteries and veins. Sometimes, it also causes low platelet counts.
4. Why do lupus patients get these antiphospholipid antibodies?
Why lupus patients develop antiphospholipid autoantibodies (aPL) is not completely understood. The production of these autoantibodies likely is triggered by an environmental factor, such as an infection occurring in an individual with a genetic susceptibility that makes him or her more susceptible to the disease. 10 to 40% of SLE patients have positive antiphospholipid antibody tests; however, the incidence of clinical APS in them is relatively low(5-10%).
5. How common are these antibodies in the general population?
Antiphospholipid antibodies are found in 1-5% of the normal population. But, incidence of APS is approximately 5 cases per 100,000 persons per year, and the prevalence is approximately 40-50 cases per 100, 000 persons.
6. When would one want to check for these antibodies?
People who develop blood clots especially in young age, repeated miscarriages, low platelet count, or have autoimmune diseases like lupus etc are advised tests for antiphospholipid antibody.
7. What should one watch out for when detected positive for them? Any Do’s and Don’ts?
Birth control pills, smoking and long duration air travel may increase risk of clotting. These are to be avoided. Pain and swelling of the legs and arms, shortness of breath, chest pain, coughing up blood-streaked sputum, numbness, paralysis or weakness of face or limbs, slurred speech are some of the symptoms related to blood clots. You should call your doctor as soon as possible if you develop these symptoms.
8. Are there any preventive measures to be taken during long flights?
Drink plenty of water, discuss with your doctor before planning long travel. Wiggle your toes or keep moving your feet while sitting in the same position during prolonged travel. In addition, compression stockings could be worn in high risk patients.
9. Why do lupus patients get these antiphospholipid antibodies?
Lupus is a disease characterised by the presence of many different types of autoantibodies. Antiphospholipid antibodies are one of them. In fact, they were first discovered in lupus patients.
10. What are their implications during pregnancy and postpartum period in APS patients?
Some of the concerns in antiphospholipid antibodies positive pregnant patients are as follows:
- - Miscarriages, which can occur early i.e. within week ten of gestation (35%) and late in the pregnancy i.e. between week ten of gestation and delivery (17%).
- - Preterm delivery i.e., before week thirty-four of gestation (11%).
- - Intrauterine growth restriction.
- - Blood clots during pregnancy and up to six weeks following the birth of the baby (also referred to as the post-partum period).
- - What are the effects of antiphospholipid antibodies on new born children?
- - Most APS patients give birth to healthy babies
- - Passive transfer of antibodies to the fetus, may result in an increased risk of prematurity, low birth weight, intrauterine growth restriction, thrombocytopenia, and developmental delay.
- - Antiphospholipid antibodies may have an impact on neurodevelopment during fetal life.
- - Although rare, persistence of these antibodies in the neonate may lead to thromboembolism, particularly if there is a concurrent infection and/or inherited thrombophilic disorders.
- - However, the antibodies tend to disappear within the first six months and usually do not result in blood clots in the baby.
- - Neonates born to mothers with antiphospholipid antibody syndrome should have close neurodevelopment follow-up.
11. Do they affect fertility?
Yes, they do.
- Antiphospholipid antibodies interfere with the endometrial decidualization an consequently, with the embryo implantation.
- According to data, the prevalence of aPL in infertile women varies from 4% to 66% and infertility is most commonly linked to presence of Anti b2 GPI antibodies.
12. Don’t anticoagulants used for its treatment cause bleeding, especially heavy menstrual bleeds?
Yes, they do increase the risk of bleeding. A delicate balance needs to be maintained between risk of bleeding and risk of thrombosis. Discuss with the doctor if such issues arise.
Key messages:
- Present treatment for the prevention of the obstetrical complication is quite effective. The majority of the women can have healthy babies.
AND,
- While antiphospholipid syndrome is an autoimmune disease, its diagnosis does not necessarily mean that a patient will develop another autoimmune condition.
Prof. Uma Kumar
Head, Department of Rheumatology
AIIMS, New Delhi