Antiphospholipid antibodies in medical practice: a review.

Abstract

BACKGROUND: Antiphospholipid antibodies are autoantibodies that have been associated with . thrombosis and recurrent foetal loss. The purpose of this review is to highlight the history of these antibodies, their epidemiology, to document what is known of their pathogenesis, clinical features, diagnosis and available treatment modalities. METHODS: Literature on the subject was reviewed using manual library search, articles in journals, internet search and conference abstracts. RESULT: Antiphospholipid antibodies have been detected in all age groups; incidence increases with age. They are antibodies to protein-phospholipid complexes and not to phospholipid alone. The most commonly detected antiphospholipid antibodies are lupusanticoagulant (LA), anticardiolipin antibodies and anti--2 glycoprotein-1 antibodies. Apart from thrombosis and recurrent foetal loss, they are also associated with neurologic disorders, cutaneous manifestations and thrombocytopaenia. CONCLUSION: Early detection requires a strong index of suspicion especially when thrombosis is seen at unusual sites. Several modalities of treatment such as anticoagulants and antiplatelet agents have been developed, though it is difficult to monitor level of anticoagulation as the antibodies may interfere with coagulation studies. Grey areas remain in the management of antiphospholipid antibodies; for instance it is not certain if patients with a positive laboratory test without any clinical feature should be treated.