Antiphospholipid Syndrome and its Clinical Manifestations

Overview

Background:
Hypercoagulation state conditioned by antiphospholipid syndrome (APS) may be the cause of severe damage of many organs.Objective: To assess the most frequent manifestations of damage of different systems in our patients with antiphospholipid antibodies (APLA).Patients and methds: In tase of the presence of APLA in sernm the authors re-evaluated retrospectively the clinical condition of the patients hospitalized at the IInd Medical and Neurological Clinic from 1995 till 2000. The authors focused their attention on the presence and charakter of clinical manifestations associated with thrombotic attacks in different organs. For assessment of anticardiolipin antibodies (aCLA) they used the sandwich method of enzymatic immunoanalysis (ELISA) in the modification of Cebecauer, for assessment of lipid anticoagulant (LA) neutralization and coagulation tests.Results: aCLA positivity in suspected hypercoagulation states was recorded in 79 patients (20.2%). Manifested thrombotic attacks were observed in 20 patients (25%). The mean age of the patients was 49.4±10 years. aCLA positivity in isotypes IgG and IgM was found in 4 patients. Twelve patients had only the IgG isotype. All aCL subclasses (IgG, IgM, IgA) were present in two patients. In 4 patients the lupus anticoagulant factor was positive. Thrombocytopenia was found in 14 patients (values below 150x109/1). The following thrombotic manifestations were observed in patients: thrombosis of the vessels of the lower extremities (9x), thrombosis of the vessels of the upper extremities (2x), thrombosis of the v. cava inferior (lx), thrombosis of the abdominal aorta (lx), mesenteric thrombosis (2x), myocardial infarction (2x), thromboembolism of the pulmonary artery (3x), cerebral infarction (8x), transient ischaemic cerebral attack (lx), impaired vision (lx), thrombosis of the cerebral sinuses (2x), transient global amnesia (lx), repeated losses of the foetus (2x).Conclusion: Thrombotic attacks in particular in younger patients who suffer at the same time from thrombocytopenia should be an indication for examination of antiphospholipid antibodies as their persistence represents a high risk of development of thromboembolis attacks.

Key words:
antiphospholipid syndrome - anticardiolipin antibodies - thrombosis.