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APA

Antiphospholipid antibodies

Antiphospholipid antibodies (APA) are a significant cause of blood clotting in pregnancy, and clotting disorders are one of the leading causes of miscarriage. Pregnancy makes the blood of all women get thicker, but the degree to which it thickens varies between women and can differ between a woman’s pregnancies. If blood gets too thick, the bonds between the blood cells change and the chances of clots forming naturally increase.

Blood clots can trigger severe problems in pregnancy, especially if clots form in the blood vessels around the placenta. Any clots here will directly restrict the flow of nutrients and oxygen to the baby. Once one clot forms, it also increases the chances of more clots forming as the immune system can go into a “stop bleeding” mode.

The immune system has a central role in regulating blood clots formation. The thicker blood is, the slower it flows, and the presence or absence of immune markers all affect the chances of clotting. Because blood is naturally thicker in pregnancy, the immune system has to adapt to the new situation and reduce the normal chances of blood clots forming.

A greater risk of clotting is called ‘thrombophilia’ (a liking to clot) and is the opposite of haemophilia (a lack of clotting). The mother having thrombophilia increases the risk of various complications in pregnancy:

  • Implantation failure.
  • Miscarriage.
  • Stillbirth.
  • Pre-term delivery.
  • Severe preeclampsia.
  • Babies with low birth weight.

Thrombophilia is a significant cause of all these conditions and is found in about 60% of women with unexplained pregnancy loss.

Phospholipids

Phospholipids are molecules that make up the cell walls of all life forms, and they perform essential roles by regulating the flow of molecules in and out of cells and their interaction with other cells. The phospholipids in cell walls determine how cells interact with other cells around them. They can make cells more ‘sticky’ (crucial for fertilization and implantation) or less sticky:

  • If they repel other cells, they can lose essential attachment functions.
  • If they’re too sticky, cells can stick together too much and “clump”.

When the phospholipid part of the immune system is unbalanced, it affects how cells’ membranes relate to other cells around them. An example is a phospholipid antibody (the anti-ethanolamine antibody) that can stop sperm from binding to an egg. If it’s identified, ICSI instantly becomes the treatment option for the couple.

Antiphospholipid antibodies can also encourage blood to clot too readily, which affects fertility in a process where:

  • The immune system triggers damage to the cell walls of the blood vessels of the placenta.
  • Blood cells then stick to the damaged cell walls and create little blood clots.
  • The clots cause inflammation, scarring and irregularity within the blood vessels.
  • The inflammatory process accelerates, and more clots form.

This process can develop further into antiphospholipid syndrome (APS) (also known as antiphospholipid antibody syndrome (APLS) or Hughes syndrome). APS is an autoimmune state where antibodies induce blood clots (thrombosis) in arteries and veins as well as small capillaries. This type of blood clotting disorder is called antiphospholipid because the immune reaction is to the phospholipids in the walls of the cells that form blood vessels. Antiphospholipid syndrome is also seen with other autoimmune diseases, including Systemic Lupus Erythematosus, Crohn’s Disease and Rheumatoid Arthritis.

Blood clotting disorders can develop in two ways:

  1. “Inherited thrombophilia” has a genetic basis for the condition and a strong association with other family members having an autoimmune disease. This connection is so strong it’s been suggested it’s the common link between the different strands of autoimmune illnesses.i Up to 1 in 20 people are believed to have an inherited predisposition to developing blood clots ii and the major causes of inherited thrombophilia are:
    • Factor V Leiden mutation (50%).
    • Prothrombin G20210 gene mutation (18%).
    • Methylene-tetra-hydro-folate-reductase (MTHFR) C677T mutation, leading to hyperhomocysteinemia.
    • Protein C and Protein S deficiencies.
  2. “Acquired thrombophilia” involves antiphospholipid antibodies forming after miscarriages, IVF failures, surgery, endometriosis or anything else that causes tissue injury:
    • Up to 30% of women with recurrent miscarriage or infertility have antiphospholipid antibodies.
    • Each pregnancy loss increases the incidence by 10%.
    • Without treatment, these women can experience a 90% miscarriage rate.

Additional risk factors for antiphospholipid antibodies

  • Exposure to viruses such as measles, chickenpox, HIV and hepatitis C.
  • Exposure to certain medications: hydralazine and phenytoin.
  • Exposure to metals, chemicals, allergens, vaccinations and physical trauma.
  • Severe burns, smoking, hypertension, obesity, pregnancy, gum disease and dehydration are also linked to APAs.

Testing and Treatment

A blood sample will show the presence of APAs, and treatment usually involves:

  1. Aspirin.
  2. Aspirin plus blood-thinning drugs such as enoxaparin (Clexane), heparin, fragmin or warfarin.

Medicinal Herbs are a viable alternative treatment for antiphospholipid antibodies, with a reported success rate of about 81% (103 patients). iv