Antiphospholipid antibodies

Antiphospholipid antibodies are defense substances that arise from a disease-related malfunction of the immune system ( autoimmune disease ) and which are directed against the body's own substances, the phospholipids . The main symptom of the disease is the occurrence of arterial and venous thromboses and embolisms in the sense of thrombophilia . Most of the women who are affected often experience pregnancy complications . These include repeated ( habitual ) miscarriages ( early abortion , spontaneous abortion ), stillbirths ( intrauterine fetal death ), prenatal growth retardation , severe preeclampsia , eclampsia and infarcts in the placenta with placental insufficiency .

The clinical picture is known as antiphospholipid syndrome or as antiphospholipid antibody syndrome . Patients with this syndrome should not be treated with direct oral anticoagulants because of the risk of recurrent thrombotic events .

causes

Antiphospholipid antibodies can appear as an independent clinical picture ( idiopathic ) or as an accompanying symptom of various other disease states, for example

in the case of collagenoses , especially in lupus erythematosus (this is where the name lupus anticoagulans comes from , because around 25 to 30 percent of patients with lupus erythematosus visceralis have corresponding antibodies),
for rheumatic diseases ,
for malignant tumors ,
in infections and
as an undesirable side effect of medication.

Laboratory and diagnosis

If thromboses or embolisms occur without an identifiable cause and / or if the above mentioned occur. A search for antiphospholipid antibodies may be indicated for complications of pregnancy. These must have been suspicious of medium to high titre twice over an interval of at least twelve weeks in order to rule out a temporary parainfectious event.

Important antiphospholipid antibodies are e.g. B .:

the lupus anticoagulant
Cardiolipin antibodies
β ₂ - glycoprotein 1 antibody
Phosphatidylserine antibodies

Naming

The name lupus anticoagulant is misleading. This is not an inhibitor of blood coagulation , as the name suggests falsely. On the contrary, lupus anticoagulans can trigger thrombosis (as a sign of excessive and not reduced coagulation ). The wrong name has its origin in laboratory medicine , because the antiphospholipid antibodies increase or lengthen some blood coagulation test values such as the partial thromboplastin time (aPTT). Hence the harmless English names lupus antibody and lupus inhibitor . The antibodies shorten the bleeding time in vivo and would lengthen it in vitro ; however, blood coagulation is accelerated in the patient and slowed down in the laboratory.

Individual evidence

↑ Walter Siegenthaler et al. (Ed.): Textbook of internal medicine. 3. Edition. Georg Thieme Verlag , Stuttgart / New York 1992, ISBN 3-13-624303-X , p. 794, Figure 10.12.
↑ Harrison's Internal Medicine. 18th edition. Volume 3, McGraw-Hill, Berlin 2012, ISBN 978-3-940615-20-6 , p. 2955.
↑ Red Hand Letter of May 23, 2019.
^ The Merck Manual. 20th edition, Merck Sharp & Dohme , Kenilworth 2018, ISBN 978-0-911910-42-1 , p. 1208.
↑ Arznei-Telegram , Volume 50, Number 11/2019 of November 15, 2019, p. 114.
↑ The Latin word lupus is identical to the Greek word lycos . What is meant is the wolf with the meaning "destructive local evil". Source: Ludwig August Kraus: Kritisch-Etymologisches medicinisches Lexikon. 3. Edition. Verlag der Deuerlich- und Dieterichschen Buchhandlung, Göttingen 1844, p. 577.
↑ Maxim Zetkin , Herbert Schaldach: Lexicon of Medicine. 16th edition. Ullstein Medical, Wiesbaden 1999, ISBN 3-86126-126-X , p. 1206.
↑ Roche Lexikon Mediin. 5th edition. Urban & Fischer , Munich / Jena 2003, ISBN 3-437-15156-8 , p. 1141.
↑ Gerd Herold : Internal Medicine 2020. Self-published , Cologne 2019, ISBN 978-3-9814660-9-6 , p. 676.
↑ Willibald Pschyrembel: Clinical Dictionary. , 267th edition. de Gruyter , Berlin / Boston 2017, ISBN 978-3-11-049497-6 , p. 1083.
↑ Therefore, the are orthography varied and the genus ambiguous: the lupus anticoagulant ( Latin ), the lupus anticoagulant , lupus anticoagulant ( English ) and other realizations with c or k, with or without hyphens , with or without Spatium and with or without capitalization .

[1] Walter Siegenthaler et al. (Ed.): Textbook of internal medicine. 3. Edition. Georg Thieme Verlag , Stuttgart / New York 1992, ISBN 3-13-624303-X , p. 794, Figure 10.12.

[2] Harrison's Internal Medicine. 18th edition. Volume 3, McGraw-Hill, Berlin 2012, ISBN 978-3-940615-20-6 , p. 2955.

[3] Red Hand Letter of May 23, 2019.

[4] The Merck Manual. 20th edition, Merck Sharp & Dohme , Kenilworth 2018, ISBN 978-0-911910-42-1 , p. 1208.

[5] Arznei-Telegram , Volume 50, Number 11/2019 of November 15, 2019, p. 114.

[6] The Latin word lupus is identical to the Greek word lycos . What is meant is the wolf with the meaning "destructive local evil". Source: Ludwig August Kraus: Kritisch-Etymologisches medicinisches Lexikon. 3. Edition. Verlag der Deuerlich- und Dieterichschen Buchhandlung, Göttingen 1844, p. 577.

[7] Maxim Zetkin , Herbert Schaldach: Lexicon of Medicine. 16th edition. Ullstein Medical, Wiesbaden 1999, ISBN 3-86126-126-X , p. 1206.

[8] Roche Lexikon Mediin. 5th edition. Urban & Fischer , Munich / Jena 2003, ISBN 3-437-15156-8 , p. 1141.

[9] Gerd Herold : Internal Medicine 2020. Self-published , Cologne 2019, ISBN 978-3-9814660-9-6 , p. 676.

[10] Willibald Pschyrembel: Clinical Dictionary. , 267th edition. de Gruyter , Berlin / Boston 2017, ISBN 978-3-11-049497-6 , p. 1083.

[11] Therefore, the are orthography varied and the genus ambiguous: the lupus anticoagulant ( Latin ), the lupus anticoagulant , lupus anticoagulant ( English ) and other realizations with c or k, with or without hyphens , with or without Spatium and with or without capitalization .