Case of the Month: March's Diagnosis Antiphospholipid Syndrome

1The evolving information has described 2 major clinical criteria. The first criterion is 1 or more clinical episodes of arterial venous thrombosis, confirmed by imaging or dipolar studies. Histopathology should demonstrate thrombosis without significant information. The second clinical manifestation is increased fetal wastage beyond the 10th week of gestation, with no evidence of abnormal fetal morphology as determined by ultrasonography or direct examination of the fetus. The syndrome is also characterized by 1 or more premature births of normal neonates at or before the 34th week of gestation secondary to severe preeclampsia, eclampsia, or placental insufficiency. Furthermore, the syndrome may be characterized by 3 or more unexplained consecutive spontaneous miscarriages before the 10th week of gestation. The laboratory criteria for the diagnosis of antiphospholidpid syndrome involve 2 classes of antibody determination. These methods of determination are the standard enzyme-link immunoabsorption assay for beta-2 glycoprotein I‐dependent anticardiolipin antibodies and a functional assay called the lupus anticoagulant. Numerous tests to detect prolonged anticoagulation time have been employed. These tests include activated partial thromboplastin time, kaolin clotting time, dilute Russell’s viper venom time, and dilute prothrombin time. The lupus anticoagulant cannot be corrected by mixing with normal platelet-poor plasma; however, shortening or correction of the prolonged coagulation time can occur with the addition of excess phospholipid. A definite diagnosis of the antiphospholipid syndrome is made if one of the clinical criterion plus one of the laboratory criterion is met. Information concerning the antiphospholipid syndrome is rapidly evolving. Anticardiolipin antibodies have been known since the turn of the last century, when a complement fixating extract of bovine hearts was employed to detect syphilis. In the 1940s, the relevant antigen was determined to be a cardiolipin. Further studies in patients with systemic lupus erythematosus determined a significant number of these patients had a false-positive test for syphilis using the Venereal Disease Research Laboratory assay. 2