Antiphospholipid syndrome: symptoms

Symptoms of the antiphospholipid syndrome make it possible to diagnose the disease on the basis of the application of diagnostic criteria adopted at the 8th congress on antiphospholipid antibodies in Sapporo (Japan) in 1998.

These include clinical and laboratory criteria.

[1], [2], [3], [4], [5]

Clinical criteria for antiphospholipid syndrome

• Vascular thrombosis: one or more clinical episodes of venous, arterial thrombosis or thrombosis of small vessels of any location, confirmed by Doppler or histological examination, and histological examination of thrombosis should not be accompanied by signs of vascular wall inflammation (vasculitis).
• Pathology of pregnancy:
  • one or more unexplained antenatal death of a morphologically normal fetus (confirmed by ultrasound or pathomorphological examination) in terms of more than 10 weeks gestation;
  • one or more premature births with a morphologically normal fetus up to 34 weeks of gestation due to severe pre-eclampsia or severe placental insufficiency;
  • three and more unexplained spontaneous miscarriages up to 10 weeks of pregnancy after exclusion of anatomical abnormalities, hormonal disorders in the mother, chromosomal pathology of the parents.

[6], [7], [8], [9],

Laboratory criteria for antiphospholipid syndrome

• Identification in blood of anti-cardiolipin antibodies of immunoglobulins class G (IgG) and / or immunoglobulins of class M (IgM) in middle or high titer (increase at least twice) with an interval of 6 weeks by standardized method of enzyme immunoassay for measurement of (2-glycoprotein-dependent antibodies to cardiolipin ACL).
• Determination of lupous anticoagulant in plasma (increase at least twice) with an interval of at least 6 weeks according to the methods, according to the recommendations of the International Society of Thrombosis and Hemostasis, which includes the following stages:
  • ascertaining the elongation of the phospholipid-dependent phase of plasma clotting by screening tests such as activated partial thromboplastin time (aPTT), kaolin time, Russell dilution test, prothrombin time with dilution;
  • the inability to correct the extended time of screening tests by mixing with normal platelet free plasma;
  • shortening the time of screening tests or normalizing it after adding an excess of phospholipids to the test plasma and excluding other coagulopathies, such as the presence of a factor VIII inhibitor or heparin. The diagnosis of antiphospholipid syndrome is reliable in the presence of at least 1 clinical and 1 laboratory criteria.

Assume antiphospholipid syndrome can be in the presence of autoimmune diseases, habitual miscarriage, with the early development of gestosis, especially its severe forms, placental insufficiency, fetal hypotrophy during previous pregnancies, thrombocytopenia of unclear etiology, false-positive reactions of Wasserman.

Other symptoms of antiphospholipid syndrome include:

• skin manifestations (reticulum liveo, acrocyanosis, chronic shin ulcers, photosensitivity, discoid rash, capillaritis);
• neurologic manifestations (migraine, chorea, epilepsy);
• endocarditis;
• serosites (pleurisy, pericarditis);
• aseptic necrosis of the head of the femur;
• impaired renal function (proteinuria, cylindruria);
• autoimmune thrombocytopenia (petechial rash).