[Antiphospholipid antibodies (aPL): detection and clinical significance]

[Obstetrical complications of antiphospholipid syndrome]

Spontaneous miscarriages and fetal deaths take part of the definition of the antiphospholipid syndrome. Preeclampsia, fetal distress, preterm delivery, intrauterine growth retardation, mother's or newborn's vascular thrombosis are also included in the spectrum of clinical events linked to the antiphospholipid antibodies in pregnant women. The pathogenesis is not fully understood, but involves interactions between antibodies and phospholipidic molecules that are complexed to plasmatic proteins of the coagulation, or present on endothelial cell and platelet surfaces. The poor spontaneous prognosis of pregnancy in the context of the antiphospholipid syndrome is dramatically improved by preventive treatment. Therapeutic options are not codified and are various combinations of low-dose aspirin, heparin, steroids, intravenous immunoglobulins, and fish-oil derivatives. Excellent obstetrical care is mandatory in every case.

Prevalence and significance of anticardiolipin antibodies in Crohn's disease

Crohn's disease is a chronic inflammatory bowel syndrome in which thrombotic complications occur in the active phase. Phospholipid-binding antibodies such as anticardiolipin antibodies and lupus anticoagulants have been shown to be associated with thrombosis. Their presence has been assessed in a group of 50 patients with Crohn's disease among whom 44 had active disease. The overall prevalence of anticardiolipin antibodies was about 22%, while none of these patients had lupus anticoagulant. Anticardiolipin antibodies have been observed in both active and quiescent CD and their presence does not seem to be related to the site of CD lesions. The presence of phospholipid-binding antibodies could be a sign of vascular alterations that are potentially thrombogenic per se, and their predictive value with respect to the specific inflammatory syndrome of Crohn's disease is discussed.

[Polyneuropathies and myelopathy associated with a circulating anticoagulant. Apropos of 4 cases]

During one year from July 1992 to July 1993, we performed usual hemostasis tests in a population or 3,700 patients. We found 12 patients with a lupus like anticoagulant (incidence: 1/1,000). Among these 12, four had unexplained polyneuropathy or myélopathy. Lupus like anticoagulant was either isolated (two cases), either associated with thrombosis (two cases). We report these four cases and we discuss the causal or uncasual nature of this association.

[What criteria for the diagnosis of antiphospholipid syndrome?]

The "historical" definition of the antiphospholipid syndrome is the most widely used: history of at least one venous and/or arterial thrombosis and/or two miscarriages, and positive tests for lupus anticoagulant and/or anticardiolipin antibodies, on two occasions more than 8 weeks apart. More recently, a Mexican group proposed another definition taking into account the number of clinical manifestations and the titer of anticardiolipin antibodies to categorize patients as definite, probable or doubtful antiphospholipid syndrome. The respective merits and limitations of both definitions are discussed.