APS

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Phospholipids are compounds that form the membranes, or walls, of cells. They are long compounds that line up side-by-side in a vertical array, much like a picket fence, to form the cell wall. The outside of a phospholipid is hydrophobic (repels water) while the inside is hydrophilic (attracts water). This arrangement allows things like oxygen, carbon dioxide, and urea to easily pass in and out of cells. Phospholipids are found in many foods including egg yolks, mayonnaise, soybeans, sunflowers, corn, and cotton seeds. The pharmaceutical industry uses phospholipids in drug delivery systems for some medications (i.e. Valium).

For reasons that are as yet not fully understood, some people develop antibodies to phospholipids. The formation of these antibodies is thought to result from an interaction of genetic and environmental factors. The resulting disorder from the formation of these antibodies is called antiphospholipid syndrome (APS). APS is associated with blood clots and pregnancy complications including fetal death after 10 weeks of gestation and early or multiple miscarriages. In other words, APS is usually diagnosed at an early age. APS, which can be diagnosed with a blood test, should be looked for in young people with unexplained strokes and blood clots and women with multiple miscarriages. APS antibodies create a hypercoagulable state (high risk of blood clots) by activating platelets, white blood cells, and the endothelium (inner lining of blood vessels) and by interfering with the body’s natural anti-clotting mechanisms.

A diagnosis of APS requires the presence of at least one of the three known antiphospholipid antibodies, namely anticardiolipin antibodies, anti-B2 glycoprotein I antibodies, and lupus anticoagulant. Because these antibodies may be transiently elevated in some individuals with rheumatological disorders, infections, and certain cancers, the blood testing for these antibodies must be positive on at least two separate tests done more than 12 weeks apart. As the main effects of APS are strokes and blood clots, people with APS must be on lifetime anticoagulation. One problem with testing for APS is the fact that anticoagulants including heparin, low-molecular weight heparin (Lovenox), warfarin, and other oral anticoagulants (Xarelto, Brilinta, etc.) can interfere with testing for the lupus anticoagulant antibody, so if that antibody must be tested for it, it must be done while the patient is not taking these medications.

In short, anyone under age 45 who presents with unexplained strokes or blood clots including phlebitis of the leg and/or pulmonary embolism or with multiple pregnancy complications should be tested for antiphospholipid syndrome.

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