Antiphospholipid antibodies(APL)

Antiphospholipid Syndrome (APL) is an autoimmune thrombophilic condition that is

marked by the presence in blood of antibodies that recognize and attack
phospholipid-binding proteins, rather than phospholipid itself

Obstetric features of APL are:

Unexplained fetal death or stillbirth
Recurrent pregnancy loss ( 3 or more spontaneous abortions with no more than 1 live
birth)
Unexplained second or third trimester fetal death
Severe preeclampsia at less than 34 weeks of gestation
Unexplained severe fetal growth restriction

Etiology

APL does not have a known etiology. There are several hypotheses to explain the probable cause
which are:

Passive transfer of maternal antibodies mediate autoimmune disorders in the fetus and
newborn.

Familial occurrence of APL has been reported, and suggested genetic associations include
HLA-DR4, DR7, DRw53 and C4 null allele .

Phospholipid molecules are ubiquitous in nature and are present in the inner surface of
the cell and in microorganisms. Therefore, during infectious disease processes, including
viral (eg, HIV,EBV and CMV), bacterial , spirochetal and parasitic ; the disruption of
cellular membranes may occur during cell damage. Phospholipids release and stimulate
APL antibodies.

Pathophysiology

Biologic effects mediated by the human APL antibodies include the following:

APL activate endothelial cells and these express adhesion molecules (such as intercellular
cell adhesion molecule-1, vascular cell adhesion molecule-1, E-selectin) and upregulates
the production of tissue factor .
 APL activate monocytes and induce their increased tissue factor expression .

APL activate platelets that increase expression of glycoprotein 2b-3a and synthesis of
thromboxane A2.The activation of endothelial cells, monocytes, and platelets by
antiphospholipid antibodies, conducting to the increased synthesis of tissue factor and
thromboxane A2, this further induces a procoagulant state.

Interaction of antiphospholipid antibodies with proteins implicated in clotting regulation,

such as prothrombin, factor X, protein C and S, and plasmin tissue factor pathway inhibitor,
might hinder the inactivation of procoagulant factors and prevents fibrinolysis

Complications of APL:

Recurrent miscarriage, early delivery, oligohydramnios, prematurity, intrauterine growth

restriction, fetal distress, pre-eclampsia/eclampsia, HELLP syndrome, venous thrombosis and
placental insufficiency.

Reference:

Fosca. A.etc.(2011). Antiphospholipid Syndrome during pregnancy: the state of the art. Journal
of prenatal medicine.
Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279165/[Accessed on 14th
February 2017]

Theresa.G(2017). Antiphospholipid Syndrome and Pregnancy. Medscape.

Retrived from: http://emedicine.medscape.com/article/261691-medication [Accessed on 14th
February 2017].