Clinical manifestations associated with Antiphospholipid Antibodies
- • Migraine headaches (controversial) (20%). Some physicians give a 3- to 4-week trial of low-molecular-weight heparin (LMWH) to see if headaches are improved.
- • Seizures (even with normal brain MRI).
- • Livedo reticularis (24%).
- • Valve disease (12%)—mitral > aortic valve. Occurs in 10% to 50% of patients with aPL abs and SLE. Can cause embolic strokes, and 5% need valve replacement. Thickening of the proximal or middle part of the valve is most common. Valve vegetations occur on the atrial face of the edge of mitral valve or vascular face of the aortic valve.
Pearl : rule out severe mitral regurgitation in a patient with APS presenting with DAH as the DAH may be due to pulmonary hypertension from an abnormal valve and not pulmonary capillaritis/clot. Treatment in that case is valve replacement and not immunosuppression.
- • Accelerated atherosclerosis.
- • Thrombocytopenia (30%): most commonly between 50,000 and 150,000/mm 3 .
- – In patients with platelet counts <20,000/mm 3 , consider an associated thrombotic microangiopathy (see Question 20).
- – Hemolytic anemia (Coombs positive) (10%): frequently associated with IgM aCL abs.
- – In patients who are Coombs negative and have schistocytes, consider an associated thrombotic microangiopathy (see Question 20).
- • Endocrine: adrenal or pituitary infarction.
