There is a disease that can cause infertility and recurrent miscarriages, but its harm goes far beyond that!

Author: Mu Rong, Chief Physician, Peking University Third Hospital

Reviewer: Wu Xueyan, Chief Physician, Peking Union Medical College Hospital

I believe most people have never heard of antiphospholipid syndrome.

With the increasing number of infertility and recurrent miscarriages, screening of these people has revealed that many of them carry antiphospholipid antibodies and suffer from antiphospholipid syndrome.

An epidemiological survey conducted abroad suggests that among people with recurrent miscarriage, approximately 20% are caused by antiphospholipid syndrome, and among people with infertility, approximately 10%-15% are caused by antiphospholipid syndrome.

Figure 1 Original copyright image, no permission to reprint

So, what exactly is antiphospholipid syndrome? In addition to causing infertility and recurrent miscarriage, what other harms does it have? How can it be treated?

1. What is antiphospholipid syndrome?

Antiphospholipid syndrome is a relatively "young" disease. It was first proposed in a magazine in 1983. Because an antibody called antiphospholipid antibody can be detected in the blood of these patients, this type of disease is named antiphospholipid syndrome.

At present, it is found that some patients with antiphospholipid syndrome have susceptible gene loci, that is, they carry genes that are prone to cause this disease, but the genetic correlation is not high. Based on this constitution, if there are external factors, such as infection and other inducements, the autoimmune function will be disturbed and antiphospholipid antibodies will be produced.

2. What are the dangers of antiphospholipid syndrome?

Antiphospholipid antibodies attack the phospholipid components in the body. There are phospholipid components on the surface of cell membranes, and tissues and cells rich in phospholipids are easily attacked.

The phospholipid component on the surface of platelets is very rich and easily attacked, leading to a decrease in platelets. If the platelet count decreases significantly, it will cause very serious bleeding. If the bleeding occurs in a relatively important organ, such as the brain, the consequences will be very serious.

The coagulation components are also easily attacked, which can easily lead to blood clots. For example, blood clots in the cerebral blood vessels can lead to cerebral infarction, blood clots in the lower limb blood vessels can lead to lower limb edema or even limb gangrene, and blood clots in the pulmonary blood vessels can cause severe pulmonary embolism and may lead to sudden death.

When the heart valve is attacked, it will cause heart valve diseases, such as mitral stenosis and insufficiency.

The placenta is attacked after pregnancy, making miscarriage more likely to occur, especially in the middle and late stages of pregnancy.

Figure 2 Original copyright image, no permission to reprint

Therefore, the clinical manifestations of this disease are diverse. When tissues or organs containing phospholipids in the body are attacked by antiphospholipid antibodies, corresponding symptoms will occur.

3. What tests should be done if you suspect you have antiphospholipid syndrome?

In addition to the typical clinical manifestations, one of the most important steps in diagnosing antiphospholipid syndrome is to draw blood to test for antiphospholipid antibodies. Antiphospholipid antibodies are actually a large group of antibodies, and there are currently at least 30 types that can be called antiphospholipid antibodies.

There are three types of antibodies that are often tested in clinical practice and must be tested for this disease: antiphospholipid antibodies, anti-β2 glycoprotein antibodies, and lupus anticoagulants. 10%-20% of patients are negative for these three antibodies. If you highly suspect antiphospholipid syndrome, you can test for other antiphospholipid antibodies, such as the PS/PT antibodies we have studied.

4. How to treat antiphospholipid syndrome?

The core treatment of antiphospholipid syndrome is anticoagulation, because this disease is very prone to thrombosis, and the simplest and most effective treatment for thrombosis is anticoagulation. Anticoagulants are selected based on the site of embolism, embolism history, and underlying diseases, and are generally based on aspirin, warfarin, and low molecular weight heparin.

In addition, most patients may have immune abnormalities and need immunomodulatory treatment, such as hydroxychloroquine. If the platelet count drops significantly, microthrombi may occur, and hormones and immunosuppressants may be used.

Therefore, treatment should be stratified according to the situation of each patient, and then an appropriate treatment plan should be selected. For most patients, as long as the disease is well controlled, they can still maintain a normal life and it will not have much impact on their lives.

So, if the antibodies turn negative after treatment, does it mean that the disease is cured? The negative antibodies can only mean that the risk of thrombosis or other complications has been reduced. Relapse is still possible if the drug is reduced or stopped. Therefore, it may be difficult for most patients to stop taking the drug for antiphospholipid syndrome.

In addition, women with antiphospholipid syndrome can give birth normally as long as they are given appropriate treatment. Different intensities of treatment are given according to the production of antibodies and medical history, such as the presence or absence of thrombosis or abortion history. The basic treatment principle is anticoagulation plus immunomodulatory drugs. Most patients may need anticoagulation treatment throughout the pregnancy, mainly using low molecular weight heparin. Currently, therapeutic drugs are very safe when used under close monitoring, have little effect on the fetus, and can play a role in preserving the fetus.

5. What should patients with antiphospholipid syndrome pay attention to in their daily lives?

In daily life, we should avoid risk factors that may cause thrombosis. For example, when taking long-distance trains or planes, we should drink more water and try to get up and move around.

Avoid using drugs that may easily cause blood clots, such as birth control pills, some drugs for treating osteoporosis, etc.

If your platelet count is particularly low, you should avoid bumps and bleeding. When your platelet count is low to a certain level, you may even need to stay in bed to reduce the risk of bleeding. This disease is actually very contradictory, as it is prone to both thrombosis and bleeding.

In addition, you should avoid infection and triggering factors in your daily life.

So far, there is basically no way to prevent antiphospholipid syndrome because the exact cause has not been found.