arterial, venous or small vessel thromboembolic events

pregnancy morbidity

trombopenie

bone marrow necrosis, TMA, AIHA

livedo reticularis

renal disease

adrenal insufficiency

kleplijden

● catastrophic APS

•History of APS and/or aPL

•Three or more new organ thromboses within a week

•Biopsy confirmation of a microthrombus

•Exclusion of other causes (DIC, HIT, TMA’s)

 

anticardiolipin antibodies (aCL) immunoglobulin G (IgG) and/or IgM enzyme-linked immunosorbent assay (ELISA)

anti-beta2-glycoprotein-I (anti-beta2GPI) antibodies IgG and/or IgM ELISA

lupus anticoagulant (LA) test

 

Dx/

Clinical criteria – One or more of the following is present:

•Vascular thrombosis – One or more episodes of venous, arterial, or small vessel thrombosis in any tissue or organ, with unequivocal imaging or histologic evidence of thrombosis. Superficial venous thrombosis does not satisfy the criteria for thrombosis for APS.

•Pregnancy morbidity – One or more unexplained deaths of a morphologically normal fetus at ≥10 weeks gestation, or one or more premature births of a morphologically normal neonate before 34 weeks gestation because of eclampsia, preeclampsia, or placental insufficiency, or three or more consecutive spontaneous pregnancy losses at <10 weeks gestation, unexplained by chromosomal abnormalities or by maternal anatomic or hormonal causes.

●Laboratory criteria – The presence of one or more of the following antiphospholipid antibodies (aPL) on two or more occasions at least 12 weeks apart:

•Immunoglobulin G (IgG) and/or IgM anticardiolipin antibodies (aCL) in moderate or high titer (>40 GPL or MPL units, respectively, or a titer >99th percentile for the testing laboratory), measured by a standardized enzyme-linked immunosorbent assay (ELISA).

•IgG and/or IgM anti-beta2-glycoprotein (GP) I >40 GPL or MPL units, respectively, or a titer >99th percentile for the testing laboratory, measured by a standardized ELISA according to recommended procedures [5,15].

•Lupus anticoagulant (LA) activity detected according to published guidelines

SLE  hydrochlorokinine

In those patients without SLE who have the presence of aPL but the absence of symptoms or a history of symptoms attributable to the APS, we do not recommend the use of aspirin as prophylaxis (Grade 2B). For patients with aPL and either SLE or related autoimmune systemic rheumatic disease but no manifestations of APS, we suggest low-dose aspirin. Patients with SLE should also receive HCQ.

Bij DVT en zwangerschapsproblemen ook therapeutische consequenties.