Importantly

• What is the reason for suspecting antiphospholipid syndrome (APLS)?

Suspected ApL diagnosis

• Disease history (thromboembolism, spontaneous abortion)
• Results of medical examinations (see below)
• Antibodies (ANA, anti-cardiolipin and / or beta2 glycoprotein) and / or lupus anticoagulant (coagulation laboratory)

Disease history

• Known Systemic lupus erythematosus (secondary antiphospholipid syndrome)
• Thromboembolism?
  • Deep Vein Thrombosis (DVT)
  • Pulmonary embolism
  • TIA (transient ischemic attack)
  • Stroke
  • Arterial embolisms

• Known other risk factors for thromboembolism?
  • Smoking
  • Pill
  • Leiden mutation
  • Atherosclerosis
  • Atrial fibrillation
  • Other
• Results of prior pregnancies?
  • Spontaneous abortions (period of pregnancy) and deaths
  • Please read more about pregnancy with Antifosfolipid Syndrome here

Medical examinations

• Clinical investigation findings
  • Signs of SLE or other rheumatic disease?
  • Arthritis, skin, blood (low blood cell count), kidneys (edema, urine test), heart, lungs, ANA and other antibodies
  •  Skin symptoms
    • Livedo reticularis / “Marbling” in the skin?
• Serum Antibodies
  • ANA (possibly subgroups), Cardiolipin antibody, Beta-2 glycoprotein antibody, Lupus anticoagulant (Coagulation laboratory)

• Thrombocytopenia (not often)

Referral to specialist

• Rheumatologist referral is relevant if rheumatic symptoms are present or for "secondary antiphospholipid syndrome" related to SLE or (rarer) other rheumatic disease
• Hematologist referral if a primarily APLS is suspected
• Maternity outpatient clinic / gynecologist is contacted if planned or present pregnancy

• Refferal to a specialist is preferably sent to the local rheumatological department. If requested, patients may be referred to: Rheumatology Department, OUS Rikshospitalet, PO Box 4950 Nydalen, 0424 OSLO. The department receives patients from the Health Region South East and from other regions as far as capacity is concerned.
• By primarily APLS, one can consider referral to Department of Blood Diseases, OUS

Norwegian Directorate of Health (Supervisor for referrals)

Antifosfolipid syndrome BINDVEVESSYKDOMMER.no

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