The APS elephant. A sampling of the many clinical manifestations seen in patients with APL, including the Sapporo diagnostic criteria of thrombosis and recurrent fetal loss. Many of these manifestations may be observed in clinical practice in patients with APL, although the strength of their relationship to the APS is uncertain. Thrombocytopenia is a particularly common finding in patients with APL, as demonstrated in the Comellas-Kirkerup study and other reports (adapted figure from Himmelfarb et al,¹¹ Kidney International).