Antiphospholipid Syndrome (APS) Case Files (Stillbirths and Epilepsy) by Prof Graham Hughes

Posted on April 18, 2019

Professor Graham Hughes is a Consultant Rheumatologist and the founder and editor of the international journal LUPUS,’ and Head of London Lupus Centre. In 1983 he described the clotting disorder now known as Hughes Syndrome for which he received the World Rheumatology (ILAR) Research Prize in 1993. 

  

Author Quotes 

 A geneticist studying APS must consider the wider, ‘non-thrombotic’ manifestations.

 

There are some patients who know their INR. If it falls below a certain level, and that level may high, it may be 3.8 or even 4.0, … but it’s important to follow those patients – they do know their own bodies.

 

Obstetrics doctors say miscarriage is common; statistically you have to wait until the third miscarriage before you test but I passionately really don’t believe that. If your family has one miscarriage you should be tested to prevent further miscarriages.

 

Summary 

 

Professor Hughes provides a summary of this video excerpt which consists of three more case studies.  

Starting with the case of a 49-year old female, he describes her symptoms and the initial thoughts regarding diagnosis and how she showed a dramatic improvement on warfarin. 

Moving on to patients who experience seizures and pregnancy, he describes the considerable change in fetal outcome in his lupus pregnancy clinic. 

He describes the UK’s lack of treatment in the prevention of stillbirths and how there is a 3-5-fold increase odds in stillbirth in aPL positive individuals. Prof Graham has 3 clinical questions he thinks are important for at-risk groups when determining who should be tested. 

Discussing some new data, he describes how the pregnancy outcome in mice improved 200-fold when specific intravenous Ig (sIVIG) was demonstrated as a therapeutic safe compound in treating APS early fetal loss.

In the last of the case studies for this video excerpt, Prof Hughes presents data for a 36-year old woman with classical features including 5 miscarriages and a stroke, but who tested negative for APS. 

 

Take Home Bullet Points 

  • Antiphospholipid antibodies are found in stillbirth 
  • There may be patients with sero-negative APS and new tests are needed 
  • Epilepsy in a lupus patient may indicate a need for anticoagulants 

 

References 

 

  1. Silver RM, Parker CB, Reddy UM, et al. Antiphospholipid antibodies in stillbirth. Obstet Gynecol. 2013;122(3):641-657.  
  2. Blank M, Anafi L, Zandman-Goddard G, et al. The efficacy of specific IVIG anti-idiotypic antibodies in antiphospholipid syndrome (APS): trophoblast invasiveness and APS animal model. Int Immunol. 2007;19(7):857-865. 
  3. Ortona E, Capozzi A, Colasanti T, et al. Vimentin/cardiolipin complex as a new antigenic target of the antiphospholipid syndrome. Blood. 2010;116(16):2960-2967. 
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