American Medical Association Family Medical Guide - American Medical Association [641]
Antiphospholipid Antibody Syndrome
Antiphospholipid antibody syndrome is a condition in which blood clots spontaneously form in the veins and arteries. The cause of this condition is not known. The blood clots form when abnormal antibodies (infection-fighting proteins) in the blood interact with cells in the blood or in blood vessels, stimulating them to form a clot. The disorder can be present in some people with autoimmune disorders such as systemic lupus erythematosus (see page 920), rheumatoid arthritis (see page 918), or certain types of thyroid disease, but it can also occur in people who do not have an autoimmune disease.
Antiphospholipid antibody syndrome also may appear during a bacterial or viral infection such as syphilis (see page 483) or Lyme disease (see page 942), and disappear after the infection goes away. The abnormal antibodies can even be present in people without a medical condition. Certain drugs—such as the epilepsy drug phenytoin, antibiotics, cocaine, and antimalarial drugs—also can cause antiphospholipid antibodies to be produced in the blood. Discontinuing the drug will stop the abnormal blood clotting.
Antiphospholipid antibody syndrome carries special risks during pregnancy. Miscarriage early or late in pregnancy and stillbirth are common in women with the disorder. The placenta may be small and the fetus may have retarded growth. Affected women have an increased risk of a potentially dangerous condition called preeclampsia (see page 526)—a sudden increase in blood pressure, protein in the urine, or both during pregnancy. All pregnancies in women with antiphospholipid antibody syndrome are considered high-risk pregnancies.
Women with antiphospholipid antibody syndrome have an even higher risk of blood clots when taking birth-control pills, so they need to use other methods of birth control (see page 470). Smoking also dramatically raises the risk of blood clots in people who have the syndrome.
Symptoms
In a person with antiphospholipid antibody syndrome, blood clots appear in the leg or arm veins and can travel to the lungs, causing a life-threatening pulmonary embolism (see page 606). Other common symptoms include sudden vision loss, numbness or weakness in the face or limbs, purplish discoloration of the skin, seizures, stroke, or recurring pregnancy loss. Multiple strokes can lead to dementia (see page 689). All of these symptoms result from blood clots that develop in small or medium blood vessels. People with the disorder usually experience only a few of these symptoms.
Diagnosis
To diagnose antiphospholipid antibody syndrome, the doctor will take a complete health history, perform a physical examination, and order a series of blood tests to detect abnormal blood clotting and the antiphospholipid antibodies. The most important of these tests are the lupus anticoagulant test and the anticardiolipin antibodies test.
Treatment
The treatment of antiphospholipid antibody syndrome is tailored to each person. The presence of blood clots requires anticlotting medication such as heparin or warfarin, sometimes combined with aspirin. People with an autoimmune disorder may need to take corticosteroid drugs such as prednisone to suppress the abnormal immune system response.
Pregnant women with the disorder must also take medication to prevent blood clots in the veins that could travel to the brain or lungs. Baby aspirin, heparin, and immunoglobulin (human antibodies) are sometimes prescribed separately or in combination. Treatment during pregnancy significantly boosts the fetus’s survival rate.
Chronic Fatigue Syndrome
Chronic fatigue syndrome (CFS) refers to a variety of symptoms that differ from person to person and can last for different lengths of time. People who have CFS generally have severe fatigue that is not improved by rest and that can worsen after physical or mental activity. Their level of activity is substantially lower than it was before the onset of the illness.