An introduction to Hughes Syndrome


A simple blood test can diagnose Hughes Syndrome

Also known as ‘Antiphospholipid Syndrome’ (APS), and more colloquially as ‘Sticky Blood’, Hughes Syndrome is a major cause of:

- DVT

- TIA/Stroke

- Migraine

- Angina

- Recurrent miscarriage


Diagnosis: A simple blood test.


Hughes Syndrome is:

- A condition in which the blood has a tendency to excess clotting

- The two organs most susceptible are the brain, and, in pregnancy the placenta

- Seen by every GP

- Treatable

- Affects all age groups, especially 15 to 50 year olds

- An autoimmune disease


How common is Hughes Syndrome?


‘Sticky Blood’ has been implicated in 1 in 5 of:

- 1 in 5 DVTs

- 1 in 5 young strokes (under 45)

- 1 in 5 recurrent miscarriages

Also:

- Teenage epilepsy

- Angina (especially women under 45)

- Some cases of Lupus


Here are ten common features to look out for…


1. DVT

- Deep vein thrombosis

- Most commonly in the leg (also arm)

- Acute pain and calf swelling

- Can lead to lung clot (pulmonary embolus)

Can follow:

- Trauma

- Surgery

- Immobility


2. Migraine

- Headaches are common in Hughes Syndrome

- Frequently migrainous

- Often starts in teens

- May improve only to return later

- Sometimes familial

- Often improve with anticoagulant


3. TIA and stroke

- Can occur at any age (e.g. 30’s)

- Stroke often proceeded by TIA’s (Transient ischemic attacks)

- Hughes Syndrome has been reported as the underlying cause of 1 in 5 strokes in women under the age of 45

- MRI may show ‘microdots’ of small vessel thrombosis


4. Miscarriage

- Hughes Syndrome is now recognised as the commonest, treatable cause of recurrent miscarriages

- Some women have suffered 15 or more miscarriages before diagnosis

- Most miscarriages are early (i.e. 3 months)

- Later complications can include IUGR (intra uterine growth retardation) and stillbirth

- Preventable in most cases with diagnosis and treatment


5. Seizures

- Increasingly recognised as a feature of Hughes Syndrome

- Up to 1 in 5 cases of idiopathic teenage epilepsy now being diagnosed with underlying Hughes Syndrome

- Can include Temporal Lobe epilepsy

- (N.B.) Other neurological features can include:

- Movement disorders e.g. chorea

- Fainting – e.g. in cases of POTS

- Severe sleep disorders e.g. narcolepsy


6. Cold Circulation

- Cold peripheries

- Livedo Reticularis (blotchy skin) – an important sign

- Recurrent leg ulcers (less common)

(There may be prominent veins e.g. on the chest wall, suggesting previous internal thrombosis)


7. Chest Pain

- Angina now recognised as a common feature of Hughes Syndrome

- Suspect Hughes Syndrome in females under 45 with angina

- Some cases have normal-looking coronary arteries on angiography (‘Syndrome X’)

Don’t forget other causes of chest pain including multiple pulmonary emboli.


8. “Atypical” MS

A number of neurological features can be seen in Hughes Syndrome. These include:

- Balance problems

- Visual disturbances

- Peripheral sensory loss

- Spinal cord problems

Not surprisingly, some Hughes Syndrome patients are suspected of having MS (Multiple Sclerosis).


9. Abdominal Pain

- Some patients suffer abdominal pain some time after (e.g. 1 hour) after a meal – ‘abdominal angina’

- In some of these patients, this symptom has been due to a localised narrowing of a major gut artery (e.g. celiac artery stenosis) thought to be secondary to localised arterial thrombosis

N.B. Similar localised areas of stenosis has been seen in other sites, e.g. renal artery stenosis.


10. Aches & Pains

Three common causes in Hughes Syndrome are:

- Fractures – especially metatarsal fracture (‘March’ fracture) thought to be secondary to bone ischemia

- Hip pain – thought to be due to ischemia in untreated Hughes Syndrome. Sometimes leads to AVN (avascular necrosis)

- Associated conditions – such as Sjogren’s Syndrome, Lupus or thyroid disease


This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

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