Background: Antiphospholipid syndrome – APS – is a systemic autoimmune disorder characterized by thrombotic venous or arterial circulation in the presence of antiphospholipid antibodies -aPL: lupus anticoagulant  -LA, anticardiolipin antibodies, and anti-beta2glycoprotein-I antibodies – anti-beta GPI. APS can be either primary or secondary when it occurs in the presence of an underlying autoimmune disorder. Pathophysiologic mechanism underlying thrombosis and pregnancy loss in APS include aPL induced cellular activation, inhibition of both natural anticoagulant and fibrinolytic system and complement activation. There is a high rate of pregnancy complications and thrombotic events especially in triple positive patients. Aspirin with low molecular weight or unfractionated heparin may reduce the incidence of pregnancy loss in obstetric APS and are therefore a standard treatment.

Aims: To present a case of obstetric APS which presented a therapeutic challenge. 

Methods: The 34 years old primigravida with APS was admitted to the Clinic in 21st  gestational week with epigastric pain, hypertension, elevated liver enzymes and low platelets. there was a positive culture of E.coli in urine and uterine cervix which were accordingly treated with antibiotics. The fetus was symmetrically hypothrophic. Due to the further decrease in platelets count till 10000 with no hemorrhagic diathesis, we investigated the presence of EBV and ADAMTS-13 level. Only heparin-dependent antiplatelet antibodies against heparin/PF4 were detected. LMWH was stopped and steroid treatment was initiated.  In 23rd gestational week a stillbirth was discovered. Before induction of abortion, the patient received platelets transfusion. The post-surgery course was uneventful but the heparin dependent antiplatelet antibodies were still detected 6 months later. 

Results: Coagulation lab-tests resultsLab-tests results 2

Conclusions: Pregnancy complications that are observed in APS may be overlapped by some other conditions. The standard treatment may not be sufficient. Recent insights into the pathogenesis of APS have led to the identification of new potential therapeutic interventions, including anti-inflammatory and immunomodulatory therapies.  

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/the-case-of-obstetric-aps-a-therapeutic-challenge/