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

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 antibody: ANA (possibly subgroups), Cardiolipin antibody, Beta-2 glycoprotein antibody, Lupus anticoagulant (Coagulation laboratory)

• Thrombocytopenia (not often)

Referral to specialist

• A rheumatologist-referral is applicable if rheumatic symptoms are present or in case of "secondary antiphospholipid syndrome" which is related to SLE or (less often) other rheumatic disease.
• Hematologist referral if a primarily APLS is suspected.
• Maternity clinic/gynaecologist contacted if planned or occurred pregnancy.

Norwegian Directorate of Health (Supervisor for referrals)

Antifosfolipid syndrome BINDVEVESSYKDOMMER.no

• Bindevevssykdommer.no
• Vaskulitt.no
• Revma Compendium