Sticky Blood Syndrome – Clots & Miscarriages
I was reminded by a gynaecologist colleague this week to write about a common condition which can result in frequent miscarriages. It is the anti-phospholipid syndrome or to make it easier to understand, the ‘sticky blood syndrome’.
Ama, a 35-year-old lady at 34 weeks of pregnancy, develops swelling of both legs and at the hospital is found to have high blood pressure and high amounts of protein in her urine which was not present at the start of her pregnancy. She develops a condition called eclampsia and loses the baby.
Alice, 30, suffers her 8th first trimester spontaneous miscarriage for unknown reasons.
Sticky blood syndrome does not only cause miscarriages or fetal losses. 26-year-old Esi starts using the oral contraceptive pill and within two weeks, she collapses at home with severe chest pain and is found to have developed a clot in her lungs. She survives.
Manu wakes up with severe pain and swelling of his right leg. He is later diagnosed with a deep vein thrombosis (DVT) which is a clot occluding the veins in his leg.
Dan, 28, is out in the club with friends when he starts complaining of headaches. Within a few minutes his friends stare at him with bemusement as his speech becomes unclear. They also note that his face has become twisted. At the hospital a scan confirms a clot in Dan’s brain which has led to a stroke.
All of these patients are eventually diagnosed with the sticky blood or anti-phospholipid syndrome (APS).
What is it?
APS is a group of clinical features associated with an antibody in the body which causes the blood to be too sticky and hence clot too easily. There are other diseases that make blood clot easily but APS is different in that it causes clots in both the veins which take blood to the heart and arteries which bring blood with oxygen from the heart to the body. It is also much more common than other diseases that make blood clot easily.
The presence of the antibody does not mean the person would develop a clot but once there are precipitating factors like smoking, dehydration, immobility, taking the pill, or getting pregnant, then the chances are higher. For example in pregnancy, when the blood gets too sticky, it doesn’t flow to the very small arteries called the capillaries leading to reduced supply of oxygen and nutrients to the fetus. A spontaneous miscarriage may occur.
Clots can also form in the placental veins, in the arteries and veins of the brain causing strokes and venous thrombosis in the deep veins of the legs or arms. This may lead to DVTs which may travel to the lungs causing a pulmonary embolus that can be rapidly fatal.
What are the signs?
- Deep vein thrombosis (DVT) in the arms or legs, especially when there is no provoking factor like long distance travel.
- Thrombosis that is a blood clot which blocks a blood vessel in the internal organs such as the brain, eye, liver, kidney and lung.
- Thrombosis of skin vessels also called livideorecticularis also causes skin ulcers.
- Brain - recurrent migraines, headaches, weakness of the limbs, strokes, seizures, memory loss.
- Limbs - circulation problems, heart attacks.
- Multiple early pregnancy losses or miscarriages.
- More than one mid-trimester pregnancy loss.
- Late pregnancy loss or fetal death especially associated with eclampsia or preeclampsia.
- Platelets are one of the components of blood that helps the body to make the blood stickier so that when you have a wound it forms a scab over it and the bleeding stops. Low levels may cause easy bruising.
This would be made in people who have the relevant symptoms. The relevant antibody is then tested for in the body using:
- The anti-cardiolipin test and the lupus anticoagulant
- VDRL test which was used to test for syphilis can also be found to be positive in a percentage of these patients that is a false positive test because they do not really have syphilis.
Although the tests measure the same thing, in some patients one or the other would be negative hence one test alone would miss the diagnosis so it’s done together. This should be confirmed to be present on 2 occasions at least 6 weeks apart.
These should be easy affordable tests but unfortunately in Ghana they are not so cheap, as requests are sent by private labs to South Africa at high costs to the patients.
For those with the antibodies but no thrombosis your doctor may decide your risk is low and just observe or put you on low dose or so-called ‘baby aspirin”.
For those with clots in the veins, they are treated with drugs called anticoagulants that thin the blood, usually warfarin to a target range of blood thinness.
Those with clots in the arteries are treated with heparin which is injected and or with junior or baby aspirin. Low dose aspirin has been found to be helpful in reducing platelet sticking together and is used in those with miscarriages, heart attacks or migraines. There are newer anticoagulants that have been developed on the market now.
Hydroxychloroquine a mild form of chloroquine has been found in lupus patients to have mild anti clotting activity and may be used routinely. Research is going on to see its further benefits in people with APS.
As reminded by my gynaecologist colleague, sticky blood syndrome or anti-phospholipid syndrome (APS) is a condition for which an intervention consisting of simple measures may result in successful pregnancies. So if your history is suggestive why don’t you ask your doctor for this test?
As always, I urge you to keep informed to stay healthy!