Methods of diagnosis of antiphospholipid syndrome
For effective diagnosis of antiphospholipidsyndrome is an important comprehensive assessment of disease progression data, the main symptoms and laboratory data. This makes it possible to properly assess the risk of complications and prescribe the necessary treatment in a timely manner. In the conduct of pregnant and postpartum women, suffering from antiphospholipid syndrome, the need for careful monitoring of the activity of the autoimmune process, the state of the blood coagulation system, prevention, diagnosis and treatment of disorders arising.
The main diagnostic criteriaantiphospholipid syndrome are references to episodes of venous and arterial thrombosis, verified data of laboratory or instrumental studies. An important role is also played by the data on the pathological course of previous pregnancies:
- spontaneous abortion before 10 weeks of pregnancy for unclear reasons, unlikely when the death of the embryo (fetus) due to genetic causes
- fetal death in terms of more than 10 weeks, premature birth, the presence of severe preeclampsia and placental insufficiency
Laboratory criteria for antiphospholipid syndrome:
- the presence of antibodies in the blood of anticardiolipin IgG or IgM class
- identification of lupus anticoagulant in blood plasma
To suggest the development of antiphospholipid syndromecan be in the presence of an autoimmune disease, recurrent miscarriage (not associated with endocrine, genetic factors, abnormal development of reproductive organs, organic or functional cervical incompetence) during the early development of preeclampsia, especially heavy its forms, placental insufficiency, malnutrition of the fetus during the previous pregnancies, false-positive reactions Wasserman.
antiphospholipid syndrome Treatment
To suppress the autoimmune processthe advisability of glucocorticoid therapy is already in preparation for pregnancy. Small doses of prednisone (5 mg) or metipred (4 mg per day) can reduce the activity of the autoimmune process and prevent violations of the blood coagulation system. Steroid therapy should be performed throughout pregnancy and during the postnatal period is 10-15 days followed by gradual withdrawal.
For the prevention of reactivation of viral infectionpatients receiving glucocorticoids in patients with syndrome antifoslipidnym spend immunoglobulin intravenous drip at a dose of 25 ml a day (3 doses). The introduction of such small doses of immunoglobulin expedient in the I trimester of pregnancy, in a period of 24 weeks before delivery.
Particular attention is paid to violations of correctionblood clotting system. When platelet activation appointed antiplatelet agents - Glockenspiel (75-150 mg daily), Trental (300-600 mg) or teonikol (0,045 mg per day). Control of blood coagulation should be performed 1 time in 2 weeks.
In cases where the pathological activityPlatelet activity is combined with an increase in the plasma and the appearance of signs link intravascular coagulation is justified use of low doses of heparin (000 IU 5 2-3 times daily subcutaneously). The duration of heparin therapy is determined by the severity of disorders of the blood system. The use of low-dose aspirin (80-100 mg daily) contributes to potentiation of the action of heparin. For the treatment of antiphospholipid syndrome is widely used low molecular weight heparins. Use of these drugs in small doses does not require strict control of the state of blood coagulation as when using conventional heparin.
As an additional method of treatmentantiphospholipid syndrome using plasmapheresis. The use of this method helps to normalize blood rheology, reduce the excessive activation of blood coagulation system, reduce the dose of corticosteroids and heparin, which is particularly important in poor tolerability. The main therapeutic effect of plasmapheresis include:
- correct rheological properties of blood
- increased sensitivity to the medication drug
Of particular importance in the treatment of patients withantiphospholipid syndrome becomes removal during the procedure of antiphospholipid autoantibodies, immune complexes, immunogenic plasma proteins, autoantigens, which reduces the activity of autoimmune process. Plasmapheresis can be used both as a preparation for pregnancy, and during it, and is an effective treatment of patients with antiphospholipid syndrome.