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Familial antiphospholipid syndrome

MedGen UID:
419641
Concept ID:
C2930802
Disease or Syndrome
Synonyms: Lupus anticoagulant, familial; Thrombotic storm
 
Monarch Initiative: MONDO:8000014
OMIM®: 107320

Definition

The designation 'antiphospholipid syndrome' was proposed for the association of arterial and venous thrombosis, recurrent fetal loss, and immune thrombocytopenia with a spectrum of autoantibodies directed against cellular phospholipid components. Anticardiolipin antibodies may react with cardiolipin and with other negatively charged phospholipids, including beta-2-glycoprotein I (B2GPI, APOH; 138700). The term 'lupus anticoagulant' refers to a heterogeneous group of antibodies, most commonly of the IgG type, that are detected by their inhibitory effect on coagulant-active phospholipid components of in vitro coagulation tests (summary by Matthey et al., 1989). Shoenfeld et al. (2008) noted that antiphospholipid syndrome is characterized by up to 30 different autoantibodies, including those against platelets, glycoproteins, coagulation factors, lamins, mitochondrial antigens, and cell surface markers. Some of these may have an additive effect on the prothrombotic tendency of the syndrome. Ruiz-Irastorza et al. (2010) reviewed pathophysiologic, clinical, diagnostic, and therapeutic advances related to the antiphospholipid syndrome. Various autoimmune disorders that cluster in families, including autoimmune thrombocytopenia (188030), are discussed elsewhere (e.g., 109100, 269200). [from OMIM]

Clinical features

From HPO
Central retinal artery occlusion
MedGen UID:
40177
Concept ID:
C0007688
Disease or Syndrome
Blockage of the main artery in the retina. The typical presentation is one of profound monocular visual loss.
Venous thrombosis
MedGen UID:
22631
Concept ID:
C0042487
Pathologic Function
Thrombophilia is a multifactorial disorder of inappropriate clot formation resulting from an interaction of genetic, acquired, and circumstantial predisposing factors. Venous thromboembolism most commonly manifests as deep vein thrombosis, which may progress to pulmonary embolism if the clot dislodges and travels to the lung. Other manifestations include thromboses of the cerebral or visceral veins and recurrent pregnancy loss (summary by Seligsohn and Lubetsky, 2001 and Varga and Kujovich, 2012). Genetic Heterogeneity of Thrombophilia THPH2 (188055) is caused by mutation in the F5 gene (612309) on chromosome 1q23; THPH3 (176860) and THPH4 (612304) are both caused by mutation in the PROC gene (612283) on 2q; THPH5 (612336) and THPH6 (614514) are caused by mutation in the PROS1 gene (176880) on 3q11; THPH7 (613118) is caused by mutation in the AT3 gene (107300) on 1q25; THPH8 (300807) is caused by mutation in the F9 gene (300746) on Xq27; THPH9 (612348) is associated with decreased release of tissue plasminogen activator (PLAT; 173370); THPH10 (612356) is caused by mutation in the HCF2 gene (142360) on 22q11; THPH11 (613116) is caused by mutation in the HRG gene (142640) on 3q27; and THPH12 (614486) is associated with variation in the THBD gene (188040) on 20p11. Susceptibility to thrombosis has also been associated with variation in additional genes, including MTHFR (607093.0003); F13B (134580.0003); plasminogen activator inhibitor (SERPINE1; 173360); and several genes encoding fibrinogen (FGA, 134820; FGB, 134830; FGG, 134850). Variation in the SERPINA10 (see 605271.0001), KNG1 (612358) and HABP2 (603924) genes has also been reported. Protection against venous thrombosis is associated with variation in the F13A1 gene (134570) on 6p25.
Arterial thrombosis
MedGen UID:
56253
Concept ID:
C0151942
Pathologic Function
The formation of a blood clot inside an artery.
Keratitis
MedGen UID:
44013
Concept ID:
C0022568
Disease or Syndrome
Inflammation of the cornea.
Scleritis
MedGen UID:
48585
Concept ID:
C0036416
Disease or Syndrome
Inflammation of the sclera.
Autoimmune thrombocytopenia
MedGen UID:
116621
Concept ID:
C0242584
Disease or Syndrome
The presence of thrombocytopenia in combination with detection of antiplatelet antibodies.
Lupus anticoagulant
MedGen UID:
1370558
Concept ID:
C4321325
Finding
Presence of lupus anticoagulant (LA) autoantibodies. LA represent a heterogeneous group of autoantibodies, IgG, IgM, or a mixture of both classes, that interfere with standard phospholipid-based coagulant tests (this is only an in vitro phenomenon, LA do not cause reduction of coagulation in vivo). The antibodies are directed against plasma proteins which also bind to phospholipid surfaces.
Iritis
MedGen UID:
7160
Concept ID:
C0022081
Disease or Syndrome
Inflammation of the iris.
Retinal detachment
MedGen UID:
19759
Concept ID:
C0035305
Disease or Syndrome
Primary or spontaneous detachment of the retina occurs due to underlying ocular disease and often involves the vitreous as well as the retina. The precipitating event is formation of a retinal tear or hole, which permits fluid to accumulate under the sensory layers of the retina and creates an intraretinal cleavage that destroys the neurosensory process of visual reception. Vitreoretinal degeneration and tear formation are painless phenomena, and in most cases, significant vitreoretinal pathology is found only after detachment of the retina starts to cause loss of vision or visual field. Without surgical intervention, retinal detachment will almost inevitably lead to total blindness (summary by McNiel and McPherson, 1971).
Retinal vasculitis
MedGen UID:
57503
Concept ID:
C0152026
Disease or Syndrome
Inflammation of retinal blood vessels as manifested by perivascular sheathing or cuffing, vascular leakage and/or occlusion.
Vitritis
MedGen UID:
68620
Concept ID:
C0235812
Disease or Syndrome
Inflammation of the vitreous body, characterized by the presence of inflammatory cells and protein exudate in the vitreous cavity.
Blurred vision
MedGen UID:
91020
Concept ID:
C0344232
Finding
Lack of sharpness of vision resulting in the inability to see fine detail.
Visual loss
MedGen UID:
784038
Concept ID:
C3665386
Finding
Loss of visual acuity (implying that vision was better at a certain time point in life). Otherwise the term reduced visual acuity should be used (or a subclass of that).

Recent clinical studies

Etiology

Alijotas-Reig J, Ferrer-Oliveras R, Esteve-Valverde E, Ruffatti A, Tincani A, Lefkou E, Bertero MT, Espinosa G, Coloma E, de Carolis S, Rovere-Querini P, Canti V, Picardo E, Fredi M, Mekinian A; EUROAPS Study Group
Am J Reprod Immunol 2016 Aug;76(2):164-71. doi: 10.1111/aji.12534. PMID: 27401589

Diagnosis

Ugan Y, Dogru A, Sahin M, Tunc SE
Z Rheumatol 2016 Oct;75(8):838-841. doi: 10.1007/s00393-016-0154-7. PMID: 27418058
Jelušić M, Starčević K, Vidović M, Dobrota S, Potočki K, Banfić L, Anić B
Rheumatol Int 2013 May;33(5):1359-62. Epub 2011 Dec 22 doi: 10.1007/s00296-011-2300-5. PMID: 22190275

Therapy

Ugan Y, Dogru A, Sahin M, Tunc SE
Z Rheumatol 2016 Oct;75(8):838-841. doi: 10.1007/s00393-016-0154-7. PMID: 27418058
Alijotas-Reig J, Ferrer-Oliveras R, Esteve-Valverde E, Ruffatti A, Tincani A, Lefkou E, Bertero MT, Espinosa G, Coloma E, de Carolis S, Rovere-Querini P, Canti V, Picardo E, Fredi M, Mekinian A; EUROAPS Study Group
Am J Reprod Immunol 2016 Aug;76(2):164-71. doi: 10.1111/aji.12534. PMID: 27401589
Paschal RD, Neff AT
Haemophilia 2013 Mar;19(2):e62-5. Epub 2012 Sep 19 doi: 10.1111/hae.12027. PMID: 22989209
Jelušić M, Starčević K, Vidović M, Dobrota S, Potočki K, Banfić L, Anić B
Rheumatol Int 2013 May;33(5):1359-62. Epub 2011 Dec 22 doi: 10.1007/s00296-011-2300-5. PMID: 22190275
Brenner B, Vulfsons SL, Lanir N, Nahir M
Br J Haematol 1996 Jul;94(1):166-7. doi: 10.1046/j.1365-2141.1996.d01-1757.x. PMID: 8757529

Clinical prediction guides

Alijotas-Reig J, Ferrer-Oliveras R, Esteve-Valverde E, Ruffatti A, Tincani A, Lefkou E, Bertero MT, Espinosa G, Coloma E, de Carolis S, Rovere-Querini P, Canti V, Picardo E, Fredi M, Mekinian A; EUROAPS Study Group
Am J Reprod Immunol 2016 Aug;76(2):164-71. doi: 10.1111/aji.12534. PMID: 27401589

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