We describe a patient with previous venous thrombosis while using oral contraceptives and recurrent pregnancy loss, who presented with massive hepatic infarction in the last trimester of the fourth gestation. Thrombocytopenia, the lupus anticoagulant (LA) and the anti-cardiolipin antibody (aCL) were detected and a diagnosis of a ‘primary’ antiphospholipid syndrome (APS) was made. The clinical and histological manifestations and the differential diagnosis, especially with DIC and pre-eclampsia, are discussed.
Alarcón-SegoviaD, CabralAR.Functional and immunochemical heterogeneity of antiphospholipid antibodies: a classification.J Rheumatol1992; 19: 1166–9.
2.
NilssonIM, AstedtB, HednerU, BereanD.Intrauterine death and circulating anticoagulant (‘antithromboplastin').Acta Med Scand1975; 197: 153–9.
3.
SoulierJP, BoffaMC.Avortements à répétition, thromboses et anticoagulant circulant anti-thromboplastine. Trois observations.Nouv Presse Med1980; 9: 859–64.
4.
FirkinBG, HowardMA, RadfordN.Possible relationship between lupus inhibitor and recurrent abortion in young women.Lancet1980; ii: 366.
5.
Duran-SuarezJR, Pigrau-SerrallachC, Bosch-GilJ, Ordi-RosJ, Triginer-BoixedaJ.Possible relationship between circulating anticoagulants and recurrent abortion.Haematológica (Pavia)1982; 67: 320–1.
BranchDW, ScottJR, KochenourNK, HershgoldE.Obstetric complications associated with the lupus anticoagulant.N Eng J Med1985; 313: 1322–6.
8.
HarrisEN, ChanJKH, AshersonRA, AberVR, GharaviAE, HughesGRV.Thrombosis, recurrent fetal loss and thrombocytopenia. Predictive value of the anticardiolipin antibody test.Arch Intern Med1986; 146: 2153–6.
9.
LockshinMD, QamarT, DruzinML, GoeiS.Antibody to cardiolipin, lupus anticoagulant, and fetal death.J Rheumatol1987; 14: 259–62.
10.
DelezeM, Alarcón-SegoviaD, Valdes-MachoE, OriaCV, Ponce de LeonS.Relationship between antiphospholipid antibodies and recurrent fetal loss in patients with systemic lupus erythematosus and apparently healthy women.J Rheumatol1989; 16: 768–72.
11.
ParkeAL, WilsonD, MaierD.The prevalence of antiphopholipid antibodies in women with recurrent spontaneous abortion, women with successful pregnancies, and women who have never been pregnant.Arthritis Rheum1991; 34: 1231–5.
12.
BranchDW, DudleyDJ, MitchellMD. Immunoglobulin G fractions from patients with antiphospholipid antibodies cause fetal death in BALB/C mice: a model for autoimmune fetal loss.Am J Obstet Gynecol1990; 163: 210–6.
13.
BakimerR, FishmanP, BlankM, SredniB, DjaldettiM, ShoenfeldY.Induction of primary antiphospholipid syndrome in mice by immunization with a human monoclonal anticardiolipin antibody (H-3).J Clin Invest1992; 89: 1558–63.
14.
LovePE, SantoroSA.Antiphospholipid antibodies: anticardiolipin and the lupus anticoagulant in systemic lupus erythematosus (SLE) and in non-SLE disorders. Prevalence and clinical significance.Ann Intern Med1990; 112: 682–98.
15.
HarrisEN, BagulayE, AshersonRA, HughesGRV.Clinical and serological features of the ‘antiphospholipid syndrome’ (APS).Br J Rheumatol1987; 26: 19.
16.
Alarcón-SegoviaD, DelezéM, OriaCV. Antiphospholipid antibodies and the antiphospholipid syndrome in systemic lupus erythematosus.Medicine (Baltimore)1989; 68: 353–65.
17.
Mackworth-YoungCG, LoizouS, WalportMJ.Primary antiphospholipid syndrome: features of patients with raised anticardiolipin antibodies and no other disorder.Ann Rheum Dis1989; 48: 362–7.
AshersonRA, KhamashtaMA, Ordi-RosJ. The ‘primary’ antiphospholipid syndrome: major clinical and serological features.Medicine (Baltimore)1989; 68: 366–74.
20.
OrdiJ, SelvaA, VilardellM. Primary antiphospholipid syndrome: a study of 29 patients.Biol Clin Hematol (Barc)1991; 13: 71–9.
21.
RosoveMH, BrewerPMC.Antiphospholipid thrombosis: clinical course after the first thrombotic event in 70 patients.Ann Intern Med1992; 117: 303–8.
22.
TanEM, CohenAS, FriesJF. The 1982 revised criteria for the classification of systemic lupus erythematosus.Arthritis Rheum1982; 25: 1271–7.
JulkunenHA.Oral contraceptives in systemic lupus erythematosus: side-effects and influence on the activity of SLE.Scand J Rheumatol1991; 20: 427–33.
34.
BremmeK, OstlundE, AlmqvistI, HeinonenK, BlombackM.Enhanced thrombin generation and fibrinolytic activity in normal pregnancy and the puerperium.Obstet Gynecol1992; 80: 132–7.
35.
SenentM, BellartJ, Zuazu-JausoroI. Markers of hypercoagulability during pregnancy: thrombin-antithrombin III complexes and dimer.Sangre (Barc)1991; 36: 21–4.
36.
ChenV, HamiltonJ, QizilbashA.Hepatic infarction. A clinicopathologic study of seven cases.Arch Pathol Lab Med1976; 100: 32–6.
BickRL.Disseminated intravascular coagulation and related syndromes: a clinical review.Semin Thromb Hemost1988; 14: 299–338.
39.
WeinsteinL.Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy.Am J Obstet Gynecol1982; 142: 159–67.
40.
Van DamPA, RenierM, BaekelandtM, BuytaertP, UyttenbroeckF.Disseminated intravascular coagulation and the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia.Obstet Gynecol1989; 73: 97–102.
41.
MartinJN, BlakePG, PerryKG, McCaulJF, HessLW, MartinRW.The natural history of HELLP syndrome: patterns of disease progression and regression.Am J Obstet Gynecol1991; 164: 1500–13.
42.
El-RoeiyA, MyersSA, GleicherN.The relatioship between autoantibodies and intrauterine growth retardation in hypertensive disorders of pregnancy.Am J Obstet Gynecol1991; 164: 1253–61.
43.
AshersonRA, CerveraR, FontJ.Multiorgan thrombotic disorders in systemic lupus erythematosus: a common link?Lupus1992; 1: 199–203.
