LE SYNDROME DES ANTI-PHOSPHOLIPIDES OBSTETRICAL: EXPERIENCE DU SERVICE DE MEDECINE INTERNE DE MARRAKECH

The antiphospholipid syndrome (APS) or Hughes syndrome is a systemic autoimmune pathology of the young subject. It is a clinico-biological entity that associates clinical manifestations such as recurrent venous and arterial thrombosis and/or repetitive obstetric complications. Due to the persistent presence in the blood, at least 12 weeks apart, of antiphospholipid antibodies. Study design: This is a retrospective study over a period of 12 years of records of patients followed for APS in the Internal Medicine Department of the Mohammed VI University Hospital of Marrakech, aiming to establish the epidemiological, clinical, biological, therapeutic and evolution of these patients. Results: Fifty-four cases of APS were collected, the mean age at onset of the first clinical manifestations of the syndrome was 36 years, with a clear female predominance (sex ratio F / H of 9.8). Thirty women (55.5%) had obstetric complications dominated by fetal loss (52%), followed by pre-eclampsia (13%), premature delivery, eclampsia and HELLP syndrome. The APS was primary in 57.4% of cases and secondary in 42.6% of cases (including 40.7% of systemic lupus erythematosus). The catastrophic antiphospholipid syndrome was noted in 2 cases (3.7%). Biologically, thrombocytopenia was found in 15% of cases and hemolytic anemia in 9.5% of cases. Immunologically, anticardiolipins, anti β2 glycoproteins and lupus anticoagulant were positive in 74%, 61% of cases and 20.4% of cases, respectively. The persistence of antiphospholipid antibodies could not be verified in 11 patients. Therapeutically, all patients with thrombosis were treated with low molecular weight heparin (LMWH) and vitamin K antagonists (VKA). Anti-platelet agents were prescribed in 40.7% of cases. The evolution was favorable in most of the cases, 3 deaths were noted of which 2 patients had presented with a catastrophic antiphospholipid syndrome(CAPS).