MaggieMae wrote:Dr. Sclafani: "i am a bit more concerned about the hypercoagulability of the antiphospholipid syndrome (Hughes sydnrome) which can mimic MS to some degree.
i am thinking to get a hematology consult on MS patients with a history of clotting problems like DVT before treatments to look for this syndrome"
My husband is scheduled to have the procedure with you at the end of this month. I had talked to my husband's PCP regarding testing for Hughes Syndrome for my husband since his niece has it. His PCP said it does not run in families. That was the end of the conversation. My husband also has two sisters with MS (one is mother of niece with Hughes). None have had any blood clotting issues in the past (except niece).
Antiphospholipid syndrome (APS) is a heterogenous disorder in terms of clinical manifestations and range of autoantibodies. In 2006, revised criteria for the diagnosis of APS were published in an international consensus statement.5 At least one clinical criterion and one laboratory criterion (discussed further in Lab Studies) must be present for a patient to be classified as having APS.
•The clinical criteria are as follows:
■One or more clinical episodes of arterial, venous, or small-vessel thrombosis in any tissue or organ confirmed by findings from imaging studies, Doppler studies, or histopathology (see Histologic Findings).
■Thrombosis may involve the cerebral vascular system, coronary arteries, pulmonary system (emboli or thromboses), arterial or venous system in the extremities, hepatic veins, renal veins, ocular arteries or veins, or adrenal glands. Investigation is warranted if a history of DVT, PE, acute ischemia, MI, or CVA (especially when recurrent) is present in a younger individual (males <55 y; females <65 y) or in the absence of other risk factors.
■One or more late-term (>10 weeks' gestation) spontaneous abortions
■One or more premature births of a morphologically healthy neonate at or before 34 weeks’ gestation because of severe preeclampsia or eclampsia or severe placental insufficiency
■Three or more unexplained, consecutive, spontaneous abortions before 10 weeks’ gestation
•Laboratory criteria: Patients must have (1) medium to high levels of immunoglobulin G (IgG) or immunoglobulin M (IgM) anticardiolipin (aCL), (2) anti–beta-2 glycoprotein I, or (3) LA on at least 2 occasions at least 12 weeks apart. (See also Lab Studies.)
Other antiphospholipid (aPL)–associated clinical features recognized by the 2006 consensus statement but not included in the criteria include cardiac valve disease, livedo reticularis, thrombocytopenia, nephropathy, and neurologic manifestations.
Thus, history of any of the following should raise the examiner's suspicion for APS:
•Thrombosis (eg, DVT/PE, MI, transient ischemic attack [TIA], or CVA, especially if recurrent, at an earlier age, or in the absence of other known risk factors)
•Miscarriage (especially late trimester or recurrent) or premature birth
•History of heart murmur or cardiac valvular vegetations
•History of hematologic abnormalities, such as thrombocytopenia or hemolytic anemia
•History of nephropathy
•Nonthrombotic neurologic symptoms, such as migraine headaches, chorea, seizures, transverse myelitis, Guillain-Barré syndrome, or dementia (rare)
•Unexplained adrenal insufficiency
•Avascular necrosis of bone in the absence of other risk factors
So, i do not think that we can propose that we work up patients simpoly because they have MS. I am considering working up patients who have a history of blood clotting
i will keep working on this