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Diagnosis of Antiphospholipid Syndrome

Testing for Hughes Syndrome, a Possible Factor in Recurrent Miscarriages

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Updated September 11, 2009

Updated September 11, 2009

Antiphospholipid syndrome, sometimes called Hughes Syndrome, is one of the few well established causes of recurrent miscarriages. The condition is an autoimmune disorder in which, for unknown reasons, a woman has developed antibodies against phospholipids (chemical compounds found on the surfaces of blood cells and in the walls of blood vessels). These antiphospholipid antibodies can lead to an increased tendency to form blood clots, which are thought to interfere with the functioning of the placenta.

Once detected and treated, usually with low-dose aspirin and/or heparin, women with antiphospholipid syndrome have a good chance of going on to have a fairly normal pregnancy. However, it's the diagnosis that can be the tricky part. To find out the consensus on how to diagnose antiphospholipid syndrome, I checked UpToDate, an electronic reference site used by many doctors and patients.

"The diagnosis requires the following:

  • An episode of blood clots, one or more miscarriages after the 10th week of pregnancy, 3 or more miscarriages prior to the 10th week of pregnancy, or one or more premature births prior to the 34th week of pregnancy due to eclampsia.
  • Antiphospholipid antibodies detected with blood testing on at least two different occasions, 12 weeks apart. Antiphospholipid antibodies include the lupus anticoagulant, anti-cardiolipin antibodies, and anti-beta-2-glycoprotein I antibodies."

So a lot of the time, a single positive blood test for one of the antiphospholipid antibodies doesn't mean that you necessarily have the syndrome. Instead, you should have the test on two separate occasions about three months apart.

Also, antiphospholipid syndrome is almost always included in the routine tests after recurrent miscarriages, but if you have had even one miscarriage after 10 weeks, a history of blood clots or pre-term delivery due to eclampsia, it can't hurt to ask your doctor about being tested before you get pregnant again. The testing involves a simple blood draw that doesn't require fasting or any other special preparation.

Here are some other questions you might have about antiphospholipid syndrome testing:

  • I've never had a blood clot. Do I need to be tested?
    Most people do not have symptoms of antiphospholipid syndrome before diagnosis other than those listed above. For many women, recurrent miscarriages are the first sign of having antiphospholipid syndrome -- and it is possible to have it even if you don't have a history of blood clots.

  • Do I have to have three miscarriages before I can be tested?
    Many doctors are willing to order the tests for antiphospholipid syndrome in women who have had two miscarriages, but specific practices will vary by the physician.

  • Who should I talk to about the testing?
    Discuss testing with your regular general practitioner or OB/GYN.

  • What's the treatment if I do have it?
    If you are diagnosed with antiphospholipid syndrome, your doctor will probably suggest you use heparin and/or low-dose aspirin when you get pregnant again.

  • Is antiphospholipid syndrome dangerous for my health?
    Having antiphospholipid syndrome does mean an elevated risk for heart problems, so it makes sense to consult with an internist or other such practitioner to discuss whether you need additional monitoring or treatment after your pregnancy. You may be advised not to use hormonal contraception given that you have an increased risk for developing blood clots.

Want to learn more? See UpToDate's topic, "The antiphospholipid syndrome," for additional in-depth medical information.

Source:

Schur, Peter H. "The antiphospholipid syndrome." UpToDate. Accessed: August 2009.

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