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Managing antiphospholipid antibodies and antiphospholipid syndrome in children
Anil V Kamat1, David P D'Cruz, Beverley J Hunt
1Department of Haematology, Guys' & St Thomas' Foundation Trust London SE1 7EH, UK.
Insights
Pediatric antiphospholipid antibodies (aPL) can be transient after infections or indicate antiphospholipid syndrome (APS). Management of thrombotic events in children with APS is challenging due to limited evidence.
Area of Science:
- Pediatric Rheumatology
- Immunology
- Hematology
Background:
- Antiphospholipid antibodies (aPL) and antiphospholipid syndrome (APS) are increasingly diagnosed in pediatric populations.
- Transient, non-pathogenic aPL are common post-infection, contrasting with rarer thrombotic events in children with true aPL.
Purpose of the Study:
- To review the clinical scenarios of children with aPL, including asymptomatic aPL, primary APS, and secondary APS.
- To discuss the manifestations and management strategies for childhood aPL and APS, supported by case histories.
Main Methods:
- Review of clinical scenarios and case histories related to pediatric aPL and APS.
- Discussion of current understanding and challenges in managing childhood aPL and APS.
Main Results:
- Thrombotic events in children with true aPL present significant management challenges.
- Limited evidence-based medicine exists for managing pediatric aPL and APS, particularly regarding anticoagulation.
Conclusions:
- Management of pediatric aPL and APS requires further investigation, especially concerning anticoagulation safety and efficacy.
- Multicenter randomized controlled trials are needed to address unresolved issues in the treatment of childhood aPL and APS.
Abstract:
Antiphospholipid antibodies (aPL) and antiphospholipid syndrome (APS) are increasingly being recognized in children. Transient non-pathogenic aPL are often seen after childhood infections, while thrombotic events seem rare in those with true aPL. We discuss the main scenarios faced when dealing with children with aPL--asymtomatic aPL, primary APS and secondary APS. Children with thrombotic events present difficult management problems, as there is little evidence-based medicine in this area. We discuss the manifestations and management of childhood aPL--asymptomatic aPL, primary and secondary APS elucidated with case histories. Insufficient safety data on anticoagulation and limited information on the effects of warfarin, use of aspirin, duration and intensity of anticoagulation are some of the unresolved issues in managing aPL and APS in children. Multicenter randomized controlled trials may provide answers to some of these issues.
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