Prevalence Of Lupus Anticoagulant Research Articles

The prevalence of Lupus Anticoagulant in Iranian children and adolescents; Current status and literature review of diagnosis

The prevalence of Lupus Anticoagulant in Iranian children and adolescents; Current status and literature review of diagnosis

Prevalence and Impact of Lupus Anticoagulant in Patients Receiving Extracorporeal Membrane Oxygenation.

Monitoring of blood coagulation is essential in ECMO patients. We investigated the prevalence of lupus anticoagulant (LA) and its association with coagulation testing and hemostaseologic complications in patients treated with ECMO. This is a retrospective analysis including adult patients who received ECMO at a medical intensive care unit at the Medical University of Vienna. The primary outcome was the prevalence of LA. Secondary outcomes included conditions associated with LA positivity, rates of bleeding and thromboembolic events, as well as the proportions of aPTT and antiXa measurements within the target range. Between 2013 and 2021 193 patients received ECMO, in 62 (32%) of whom LA diagnostics were performed. Twenty-two (35%) patients tested positive. LA positive patients had more frequently received VV ECMO (77.3% vs 34.3%; p = 0.002), were more frequently diagnosed with viral respiratory infections (SARS-CoV2: 45.5% vs 20%; p = 0.041, influenza virus: 22.7% vs 0%; p = 0.003), had a longer ECMO treatment duration (25 vs 10 days; p = 0.011) and a longer ICU stay (48 vs 25 days; p = 0.022), but similar rates of bleeding and thromboembolic events.

Antiphospholipid antibodies in the obstetric antiphospholipid syndrome: Detection and antibodies profile at the Maternity and Neonatal Medicine Center of Monastir, Tunisia.

This study aimed to implement lupus anticoagulant (LAC) detection techniques according to the International Society on Thrombosis and Hemostasis (ISTH) recommendations, in the Biological Laboratory of the Maternity and Neonatal Medicine Center (Monastir, Tunisia) and to evaluate the profile and the prevalence of antiphospholipid antibodies (aPL) in the obstetric antiphospholipid syndrome (OAPS). We collected two groups: a "case group" (53 women who presented one or more obstetrical criteria of APS) and a "control group." LAC was detected following the four steps recommended by ISTH 2009. Anticardiolipin (aCL) and antibeta-2-glycoprotein I (aβ2GPI) antibodies testing were performed by enzyme-linked immunosorbent assay (ELISA). aPL were found in five patients: three patients with isolated LAC, one patient with isolated IgG aCL, and one patient with triple positivity (LAC, aCL IgM, aβ2GPI IgM). Concerning LAC, 13 (24.52%) of 53 patients had a screening step with at least one positive test. The mixing step was positive in four patients and then confirmed in the confirmatory test. Thus, the prevalence of LAC in our study group is 7.54%. Surprisingly, among these positive patients, one patient had an associated combined factor V (FV) and factor VIII (FVIII) deficiency. There is no single test and no algorithm that can detect all types of LAC. It seems that the recent 2020 ISTH algorithm allows a better detection of low activity LAC than the 2009 algorithm. In our study, the most frequently identified antiphospholipid antibodies were LAC more than aCL and aβ2GPI.

Association of Lupus Anticoagulant status with Disease Course in SARS-CoV-2 (COVID-19) Infection.

Background: We investigated the importance of lupus anticoagulant (LA) in patients with SARS-CoV-2. Methods: Medical records of 41 SARS-CoV-2 infected patients were reviewed. Patients were classified into two groups according to the frequency of positive LA test results: “LA (−)” and “LA (+) ≥1” (LA positive at least once). Statistical analysis was performed to determine the association between LA presence and change in LA test results and disease course according to both hospital days (HD) and days after diagnosis (DD). Results: The prevalence of LA was 51.2%. Averagely, the first change in LA test result occurred during DD 12-13 and between HD 9-10. The second change occurred on DD 15-16 and HD 13-14. The presence of LA was associated with severe disease (P = .004) but was not associated with thrombotic complications or mortality. The change of results from negative to positive or vice versa or the frequency of the changes was not associated with disease severity, thrombotic complications, or mortality. Conclusions: LA positivity can be regarded as one of the findings suggesting more serious SARS-CoV-2 infection.

Lupus anticoagulant in patients with COVID-19: A review

Introduction: Coronavirus disease 2019 (COVID-19) is characterized by a pro-coagulant state that can lead to fatal thromboembolic events. A high prevalence of lupus anticoagulant has been shown in several studies that may at least partially explain the pro-coagulant profile of COVID-19. However, the relation between COVID-19 and lupus anticoagulant is arguable, and no study has clearly evaluated the concussion of lupus anticoagulant on mortality. Methods: We searched the articles that related to lupus anticoagulant and patients with COVID-19. Two authors independently reviewed the search results to select English language articles discussing lupus anticoagulant in patients with COVID-19. Results: Recent studies found conflicting results about the association between lupus anticoagulant and thromboembolic complications of COVID-19. Studies documented a high prevalence of lupus anticoagulants as well as several other studies. Patients with lupus anticoagulants were older, and their C-reactive protein, high-sensitivity troponin, and activated partial thromboplastin time (aPTT) were significantly higher than patients without lupus anticoagulants. Conclusion: Those started on therapeutic anticoagulation showed more severe and complicated involvements and a higher risk of death. According to our results, lupus anticoagulant is highly prevalent among hospitalized COVID-19 patients. Whether these antibodies promote a hypercoagulable state or they are merely a coincidence, epiphenomenon needs further evaluation.

Prevalence of antiphospholipid antibodies in Behçet's disease: A systematic review and meta-analysis.

Behçet’s disease (BD) is a multifactorial systemic inflammatory disease of unknown aetiology characterised by several clinical manifestations including vascular involvements (i.e., both arterial and venous thrombosis). Antiphospholipid antibodies (aPLs)—including anticardiolipin (aCL), anti-β2-glycoprotein I (β2-GPI) antibodies and lupus anticoagulant (LA) are detected in systemic autoimmune diseases which contribute to thrombosis. The aim of this systematic review and meta-analysis was to evaluate the prevalence of aPLs in patients with BD as compared to controls. A protocol was registered in PROSPERO (Registration No. CRD42018088125) and a systematic literature search was conducted through PubMed, Web of Science, Embase, Scopus and ScienceDirect databases. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects model. Quality assessment was carried out by using the modified 9-star Newcastle-Ottawa Scale (NOS). Publication bias was evaluated via visualisation of contour- enhanced and trim and fill funnel plots along with Begg's and Egger's tests. We included ten case-control studies (a total of 999 participants from 380 BD patients and 619 controls) based on the inclusion criteria. The prevalence of aCL (OR: 12.10, 95% CI: 5.15–28.41, p<0.00001) and anti-β2-GPI antibodies (OR: 23.57, 95% CI: 1.31–423.63, p = 0.03) were statistically significant, however, the prevalence of LA was not significant (OR: 13.77, 95% CI: 0.65–293.59, p = 0.09). The results remained statistically significant from different sensitivity analyses which represented the robustness of this meta-analysis. According to the NOS, 50.0% of the studies were considered as of high methodological quality (low risk of bias). No significant publication bias was detected from contour-enhanced and trim and fill funnel plots or Begg's and Egger’s tests. This meta-analysis established that there is a significantly high prevalence of aPLs (i.e., aCL and anti-β2-GPI antibodies) in patients with BD when compared to controls.

Evaluating antiphospolipid antibodies as contributors to thrombotic vascular complications in patients with type 2 diabetes mellitus in Enugu, Nigeria

Background: Vascular thrombotic events complicates uncontrolled type 2 Diabetes Mellitus (T2DM). Antiphospholipid antibodies can cause vascular thrombosis. These present a “double hit” of thrombotic events in T2DM. They also affect disease management and prognosis. Aim: To check serum levels of lupus anti-coagulant (LA) and immunoglobulin Beta - 2 - glycoprotein-1- anticardiolipin antibodies (IgG-B2GPI ACA) in Type 2 DM patients. Methods: This was a cross-sectional analytical study. We recruited 140 Type 2 DM patients and 70 healthy control subjects. The study centre was the diabetic clinic at University of Nigeria Teaching hospital. Assays for serum levels of LA and IgGβ2GPI-ACA in the subjectsweredone. UNTH's institutional ethics committee IEC approved the study. Results: Prevalence of LA in complicated, uncomplicated T2DM and healthy control subjects were 7.1%, 4.3%,43%. The prevalence of IgG-β2GP1-ACA was 4.3% for all the groups. The risk ratio of developing LA & IgG-B2GPI ACA in uncomplicated T2DM patients were 1.3 (95% CI: 0.37- 4.9) and 1.0 (95% CI, 0.20 - 4.78). The RR of complicated T2DM developing LA & IgG-B2GPI ACA 1.67(95% CI: 0.4-6.7) and 1.72 (95% CI: 0.39-7.48). Correlation analysis of LA, IgG-B2GPI-ACA and the presence of vascular complications in T2DM was not significant. P>0.05. Conclusion: There is no causal relationship between APLS antibodies levels and vascular complications in T2DM.

ВОЛЧАНОЧНЫЙ АНТИКОАГУЛЯНТ У БОЛЬНЫХ САХАРНЫМ ДИАБЕТОМ 2 ТИПА ПОСЛЕ КОРОНАРНОГО ШУНТИРОВАНИЯ

Цель исследования: изучить распространённость носительства волчаночного антикоагулянта (ВА) среди пациентов, подвергшихся операции коронарного шунтирования (КШ), и оценить влияние ВА на другие показатели гемостаза у этих пациентов. Материалы и методы. Обследовано 40 мужчин в возрасте от 46 до 74 лет, страдающих сахарным диабетом (СД) 2 типа, перенесших операцию КШ. Группу сравнения составили 47 мужчин, перенесших операцию КШ, не имевшие СД. У всех пациентов после операции КШ исследовали содержание в крови ВА, фибриногена, растворимых фибрин-мономерных комплексов (РФМК) и Д-димера. Результаты. Методикой «Экспресс-люпус тест» ВА был обнаружен у 65% пациентов с СД и у 61% пациентов без СД. В группе больных диабетом выявлены прямые связи умеренной силы между количественным показателем «Экспресс-люпус теста» и содержанием в крови фибриногена, РФМК и Д-димера. Заключение. Вероятно, причиной активации системы гемостаза и появления ВА у пациентов с ишемической болезнью сердца является обширное хирургическое вмешательство на сердце и сосудах с применением аппарата искусственного кровообращения. The aim: to study the prevalence of lupus anticoagulant (LA) carriage among patients undergoing coronary bypass surgery (CBG) and to assess LA effect on other hemostatic parameters in these patients. Materials and methods. We examined 40 men (46-74 years old) with diabetes mellitus (DM) type 2 after CBG. The comparison group consisted of 47 men after CBG without DM. In all patients after CBG blood levels of BA, fibrinogen, soluble fibrin-monomer complexes (SFMC) and D-dimer were studied. Results. By «Express-lupus test» method we detected VA in 65% of patients with DM and in 61% of patients without DM. In the group of patients with diabetes direct relationships of moderate strength were revealed between the quantitative parameter of «Express-lupus test» and blood levels of fibrinogen, SFMC and D-dimer. Conclusion. Probably, the cause of hemostasis activation and LA appearance in patients with coronary heart disease is extensive surgical intervention on heart and blood vessels using cardiopulmonary bypass apparatus.

Prevalence of lupus anticoagulant in women with spontaneous abortion in Zaria.

Spontaneous abortion (SA) is a common complication of pregnancy. Presence of lupus anticoagulant (LA), one of the antiphospholipid antibodies, has been associated with SA in many studies, especially in Caucasians. This study was carried out to determine the prevalence of LA in women with SA in ABUTH, Zaria. A cohort of 100 consecutive women presenting with SA with no history of thrombotic episodes were enrolled into the study. Prothrombin time (PT), kaolin clotting time (KCT), and activated partial thromboplastin time (APTT) were conducted on samples of all the participants. Eight patients had prolonged APTT, and after a 50:50 mixture of their plasma with pooled control plasma, four (50%) had uncorrected APTT. Staclot® (a hexagonal-phase phospholipid) test and calculated Rosner index for prolonged KCT were used for the confirmation of LA in samples with uncorrected APTT after mixing studies. We analyzed 100 women with one or more SA with a mean age of 31.0 ± 3.8 years. Nearly 4% and 3% of the participants were LA positive with Staclot® and KCT tests, respectively. Patients with LA were more likely to have had a past history of preeclampsia/eclampsia, small for gestational age deliveries, and previous SA (prevalence odds ratio [95% confidence interval]) of 1.9 (0.2, 20.1), 3.2 (0.3, 34.3), and 1.4 (0.1-13.6), respectively. The PT, APTT, and KCT were significantly prolonged in patients with LA (P ≤ 0.001 for each, respectively). LA may be one of the causes of SA and other adverse pregnancy outcomes such as preeclampsia/eclampsia and small for date deliveries. It is recommended that patients with prolonged APTT, uncorrected with 50:50 mixing study with pooled control plasma, should be evaluated further for LA.

Antiphospholipid antibodies among pregnant women with recurrent fetal wastage in a tertiary hospital in Northern Nigeria.

Context:The association between antiphospholipid antibodies (APAs) and pregnancy loss has been established and now considered as a treatable cause of pregnancy loss. Data on the prevalence of APA in patients with recurrent pregnancy loss are scarce in our environment.Aims:To determine the prevalence of APA in pregnant women with and without recurrent fetal wastage.Settings and Design:Antenatal clinic of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. A cross-section analytical study.Subjects and Methods:Eighty-five antenatal patients with recurrent fetal loss (cases) and an equal number of antenatal patients without recurrent fetal loss (control) matched for age were studied. Their sociodemographic data obtained and blood samples analyzed for lupus anticoagulant (LA) using activated partial thromboplastin time, direct Russel's viper venom time, hexagonal phospholipids, and IgG anticardiolipin antibody (ACA) using enzyme-linked immunosorbent assay.Statistical Analysis Used:Data were analyzed with Statistical Package for Social Sciences (version 17) by univariate analysis and Chi-square test.Results:The age range of the patients was 18–42 years with a median of 30 years. The prevalence of APA was 14.1% and 4.7% among the cases and controls, respectively. The prevalence of LA was 7.1% and 1.2% among the cases and controls, respectively, whereas ACA was 8.2% and 3.5%, respectively. However, one of the cases was positive for both APA and ACA, giving a prevalence of 1.2%.Conclusions:The prevalence of APA among antenatal patients with recurrent pregnancy loss was, at least, 3 times higher than that of normal antenatal clients. APA should be included in the investigation protocol of women with recurrent fetal wastages in our setting.

The Effect of Lupus Anticoagulant Detected in Children with Respiratory Tract Infection on in vitro Coagulation Time

Background: This study was conducted in order to investigate the prevalence of lupus anticoagulant (LA) in children with respiratory tract infection and to evaluate the effect of LA on in vitro coagulation time. Methods: This study included 46 subjects, showing positivity to Mycoplasma pneumoniae (MP) IgM antibody and 37 subjects positive to various respiratory viruses (RV). The titer of LA and PT/aPTT were examined and investigated the effect of LA on PT/aPTT. Results: None of the subjects showed any evidence of bleeding or thrombosis during conduct of the study. Positive LA (LA titer ≥1.34) was significantly more frequent in MP group (39.1%) than RV group (18.9%)(P＜0.05). Total prevalence of positive LA was 30.1%, among them 22.9% was low positive LA (1.34≤LA＜2.0) and 7.2% was high positive LA (LA≥2.0). Low LA positive group showed only mild PT prolongation (13.0＜PT ＜20 sec) and the prevalence was more frequent than LA negative group (P＜0.05). However, aPTT prolongation was not more frequent in low LA positive group than LA negative group (P＞0.05). All subjects of high LA positive group showed severe prolongation of aPTT (≥60 sec), however, severe PT prolongation (≥20 sec) was not noticed. Conclusion: The prevalence of LA was relatively high in children with respiratory tract infection, however, most of them are mildly elevated. Low LA positivity was related to the mild prolongation of PT. But high LA positivity markedly prolongs the aPTT without marked prolongation of PT.

Pancreatitis in Systemic Lupus Erythematosus - Case Series from a Tertiary Care Center in South India

Pancreatitis in Systemic Lupus Erythematosus (SLE) is a rare, but life threatening complication. We aimed to study the characteristics and treatment outcome of SLE patients with acute pancreatitis in comparison with those with abdominal pain due to causes other than pancreatitis. Records of SLE patients admitted in our ward with pain abdomen between January 2008 and July 2010 were studied retrospectively. Of 551 SLE in-patients during the study period, 28 (5%) had abdominal pain and 11 (2%) of them were diagnosed to have acute pancreatitis. Five of the 11 patients had severe pancreatitis and 6 had mild pancreatitis. Seizures, arthritis and lack of prior use of steroids were significantly more common in patients with pancreatitis as compared to those with abdominal pain of non pancreatic origin. Seizure occurred more often in severe pancreatitis group as compared to mild pancreatitis. There was no difference in prevalence of lupus anticoagulant and anticardiolipin antibody (40%) between SLE patients with pancreatitis and those with other causes of abdominal pain. Conclusion: Association of pancreatitis in our cohort of SLE patients include withdrawal of maintenance dose of steroids, seizures and arthritis in univariate analysis. However there was no independent predictor of this complication in our study.

The association of antiphospholipid antibodies with intrauterine fetal death: A case–control study

IntroductionOver the past few decades it has been recognized that antiphospholipid antibodies are associated with pregnancy loss. Other placenta-mediated pregnancy complications have also been associated with the presence of antiphospholipid antibodies. Most studies have measured antiphospholipid antibodies near the time of the event investigated. ObjectivesTo investigate the association of antiphospholipid antibodies and a history of intrauterine fetal death (IUFD) in a case–control design. Materials and methodsA case–control study of 105 women with a history of IUFD after 22 gestational weeks and 262 controls with live births. The prevalence of lupus anticoagulant, anticardiolipin- and anti-β2-glycoprotein 1 antibodies were measured 3–18years after the event of IUFD. ResultsTotal 9.5% of women with a history of IUFD and 5.0% of controls had at least one positive test for antiphospholipid antibodies (OR 2.0; 95% confidence interval (CI) 0.9-4.8). Women with a history of IUFD were significantly more often positive for lupus anticoagulant compared to controls (OR 4.3; 95% CI 1.0-18.4). The association of lupus anticoagulant with a history of IUFD was confined to women positive for other antiphospholipid antibodies in addition to lupus anticoagulant. Being positive for anti-β2-glycoprotein 1 or anticardiolipin antibodies alone was not significantly associated with a history of IUFD. ConclusionsWomen with a history of IUFD after 22 gestational weeks were more often lupus anticoagulant positive. The association was confined to women with multiple positivity for antiphospholipid antibodies, although firm conclusions on the importance of multiple positivity cannot be made from this study.

Association of antiphosphatidylserine/prothrombin antibodies with neuropsychiatric systemic lupus erythematosus

Neuropsychiatric manifestations in patients with systemic lupus erythematosus (SLE) are well-recognized symptoms although the pathophysiology of neuropsychiatric SLE (NPSLE) is unclear. Since an association with antiphospholipid antibodies has been reported, we examined the prevalence of antiphosphatidylserine-prothrombin antibodies (anti-PS/PT Abs), lupus anticoagulant (LA), anticardiolipin/beta2-glycoprotein I antibodies (anti-beta2-GPI Abs), and antiribosomal P protein antibodies (antiribosomal P Abs) in 68 SLE patients and analyzed their associations with neuropsychiatric manifestations. The prevalence of LA was significantly higher in the patients with neuropsychiatric (NP) features than those without NP features (P < 0.02). The levels of anti-PS/PT antibody were also significantly higher in the patients with NP features than those without NP features (P < 0.01). The results indicate that LA positivity and higher levels of anti-PS/PT antibody can be predictive markers for NPSLE.

A comprehensive screening analysis of antiphospholipid antibodies in Indian women with fetal loss

Objective The present study was aimed at a comprehensive analysis of acquired thrombophilia in a large series of Indian women with fetal loss. Study design Four hundred and thirty women (median age 26 years, range 18–39 years) with unexplained fetal loss (median number of abortions 3, range 1–13) were screened for the presence of antiphospholipid antibodies (APA), i.e. lupus anticoagulant (LA), IgG/M antibodies for cardiolipin (ACA), β2 glycoprotein 1 (β2 GP1) and annexin V. We also studied 100 normal healthy women (median age 24 years, range 18–30 years) who had at least one healthy child and did not have any miscarriage or other obstetric complications. Results The prevalence of persistently positive LA was 8.1% and 1% in the patients and controls, respectively (OR 8.7; 95% CI, 1.4–51; P < 0.05). The overall prevalence of IgG and/or IgM antibodies for cardiolipin, β2 GP1 and annexin V were as follows—ACA 27.9% (OR 18.9; 95% CI, 5–70; P < 0.05), β2 GP1 12.2% (OR 6.8; 95% CI, 1.8–25; P < 0.05) and annexin V 14.6% (OR 17; 95% CI, 2.9–98; P < 0.05). The conventional LA and ACA tests were positive 23.2% of the cases as against 1% in the controls (OR 14.8; 95% CI, 3.9–55; P < 0.05). The prevalence of LA, ACA, β2 GP1 and annexin V antibodies as independent risk factors were observed in 0.5%, 16.5%, 5.4% and 7.8% in the patients as against 1% each in the controls. The overall positivity for any one of the APA studied was 42.6% (OR 10.2; 95% CI, 4.5–23; P < 0.05). Conclusion The present study thus indicates the importance of APA in women experiencing fetal loss where all the conventional causes of miscarriages have been ruled out. It also suggests that conventional APA assays (LA and ACA) are effective in the detection of a majority of APA positive cases and by the addition of other cofactor-dependent (β2 GP1 and annexin V) APA assays, there is a considerable increase in the diagnostic efficiency in the detection of APA.

Lupus anticoagulant and antibodies to β2-glycoprotein I, annexin V, and cardiolipin as a cause of recurrent spontaneous abortion

The prevalence of lupus anticoagulant (LAC), anticardiolipin (ACA), anti-beta(2) glycoprotein I (beta(2)GPI), and antiannexin V antibodies were determined in 200 recurrent spontaneous abortion (RSA) patients and 200 age-matched control women. ACA IgG was associated with early, while antiannexin V IgG and LAC were associated with late, and ACA IgG, antiannexin V IgG, and LAC were associated with combined early + late RSA, thereby recommending inclusion of their screening in RSA workout.

Prevalence of Antiphospholipid Anitbodies in Idiopathic Venous Thromboembolism.

The presence of antiphospholipid antibodies (APLA), which include lupus anticoagulant (LA) and anticardiolipin antibodies (ACA), increases the risk of venous thromboembolism (VTE). Although, the association demonstrated between LA and VTE is strong, that between ACA and VTE is weak with the exception of high titers. This suggestion has been that this may be related to the induction of ACA by acute illness. This may be the explanation for the widely varying frequency of ACA positivity in patients with acute VTE in the current medical literature. The prevalence of LA in patients with acute VTE is more consistent but the value of testing for ACA and LA at presentation of acute VTE remains unknown. We routinely test all idiopathic VTE patients at presentation for LA and ACA. It had been our impression that most positive results revert to normal with subsequent testing. We sough to test this hypothesis. The objective was to determine the prevalence of abnormal LA and ACA results and the frequency of subsequent normalization in patients presenting with a first idiopathic venous thromboembolic event. A retrospective chart review was conducted at the Thrombosis Unit at the Ottawa Hospital. 278 charts of unrelated, consecutive patients with idiopathic VTE were reviewed. 232 patients with single idiopathic venous thromboembolic events with documented LA and ACA results were included. The patients were divided into two groups based on the time between the acute VTE and initial APLA test. The frequency of abnormal LA and ACA on initial and repeat tests was determined in each group. 170 and 177 patients were screened for LA and ACA within one month of the acute VTE. On initial tests, LA and ACA were detected in 14.1% and 7.9% of patients, respectively. However, LA and ACA were present in only 1.2% and 1.7% of patients, respectively, on subsequent tests. In patients screened more than one month after an acute VTE 3.8% of the 52 patients had evidence of LA on initial testing and all were positive on repeat tests. ACA were present in 8% of patients on initial tests and in 6% (75% of the initial positive results) of patients on subsequent tests. A high frequency of positive LA and ACA tests results is observed when these tests are performed at the time of presentation of acute VTE. Repeat testing beyond one month from presentation demonstrates most of the results return to normal suggesting false positive results are common at presentation. However, when the tests are performed one month or longer after the acute VTE, the frequency of positive APLA test is much lower and false positives are uncommon. Screening for APLA should not be performed until at least one month after the diagnosis of idiopathic.

The prevalence of lupus anticoagulant in normal pregnancy and in women with recurrent fetal loss—recommendations for laboratory testing for lupus anticoagulant

BACKGROUNDThere is wide disagreement in the literature on the rate of detection of lupus anticoagulant (LA) in women with recurrent fetal loss (RFL). The aim of this study was to determine the prevalence of LA using four phospholipid-dependant coagulation tests in a large population of Saudi women.PATIENTS AND METHODSWe determined the prevalence of LA in women with RFL (n=925), normal pregnancy (n=663), and in healthy blood donors (n=204), at the King Khalid University Hospital, Riyadh. The following coagulation tests were employed: the activated partial thromboplastin time (APTT), platelet neutralization procedure (PNP), kaolin clotting time (KCT) and the dilute Russel's viper venom test (dRVVT).RESULTSIn RFL patients, positive APTT was 10.2%, APTT+PNP 3.6%, KCT 10.5%, and dRVVT 10.9%. In normal pregnancy, the corresponding figures were 12.8%, 3.1%, 10.8%, and 5.6%. Three positive tests occurred in 2.3% of RFL patients, including APTT+KCT 3.5%, APTT+dRVVT 3.9%, and KCT+dRVVT 4.1%. The corresponding figures for normal pregnancy were 1.6% for three positive tests, and 3.0%, 1.8%, 2.4%, respectively. The dRVVT was the only test that showed a rate of positive results almost double that seen in normal pregnancy.CONCLUSIONSIf only one or even two screening tests were performed, a significant number of LA positive cases would have been missed. This could make a difference to treating physicians as to the possible etiology and management of RFL. It is therefore advisable to routinely use the three tests (APTT, KCT and dRRVT) when screening for LA.

Lupus anticoagulant in Nigerian women with preeclampsia.

The Lupus Anticoagulant (LA) which used to be known for its interference with coagulation studies in the 1950s, has now been recognised to be associated also with diverse disease conditions in the developed countries. Our aim therefore was to determine the prevalence of the lupus anticoagulant (LA) in women with pre-eclampsia and controls. A total of seventy-six pregnant women, were studied, twenty-six pre-eclampsia and fifty who were apparently healthy served as controls. The Kaolin clotting time test (KCT) was performed in duplicates on plasma samples from subjects and controls. Mixing ratio was calculated in order to determine the presence of the lupus anticoagulant, Kaolin clotting time ratio of greater than or equal to 1.2 was taken to signify the presence of the lupus anticoagulant. Eleven (42.3%) of the women with pre-eclampsia had prolonged KCT as against 2(4%) of the pregnant control. The clotting time of 7 of the '11 pre-eclampsia with prolonged KCT, were correctd by normal plasma, while 4 were not corrected. The KCT ratio of all 4 were greater than 1.2 signifying the presence of LA (15.4% prevalence). One (2%) of the pregnant control had KCT ratio greater than 1.2 (2%) prevalence of LA). A number of Nigeria women with pre-eclampsia also have the lupus anti-coagulant therefore African women with pre-eclampsia should be screened for the presence of lupus anticoagulant.

Lupus Anticoagulatiuon African Women With Recurrent Abortions

Objective: The presence of the lupus anticoagulant (LA) an auto antibody has been implicated as a marker for first trimester spontaneous abortions as well as second and third trimester foetal death in the Caucasians. There is paucity of information on LA in African women where recurrent abortion and obstetrics complications are still common. Our aim therefore is to determine the prevalence of lupus anticoagulant in Nigerian women with recurrent abortion Subjects and methods: A total of seventy – three pregnant women were studied. Twenty three of them had history of recurrent abortions; they were compared with 50 without obstetrics complications as controls. Coagulation studies using the kaolin clotting time were carried out on their plasma sample. Mixing experiments were conducted on samples with prolonged clotting time in order to detect the presence of the lupus anticoagulant. The anticoagulant was considered present if the kaolin clotting time ratio is greater than or equal to 1.2. Result: Nineteen {82.62%} of the patients with recurrent abortion had normal kaolin clotting time, one {4.35%} had subnormal clotting time. The kaolin clotting time ration was greater than 1.2 in one (4.35%) of the patients with recurrent abortions signifying the presence of the lupus anticoagulant. Four (8%) of the pregnant controls had subnormal kaolin clotting time, 44 (88%) had normal clotting time while 2 (4%) had prolonged clotting time. The lupus anticoagulant was present in one (2%) of the pregnant controls. Conclusion: A 4.35% prevalence of LA among Nigerians with recurrent foetal loss may necessitate the screening of pregnant women with history of recurrent abortion for the lupus anticoagulant. We recommend that screening for lupus anticoagulant should be part of the routine investigation for women with recurrent spontaneous abortions KEY WORDS: Recurrent Abortions, Pregnant Women, Lupus Anticoagulant, Kaolin clotting time Nigerian Journal of Clinical Practice Vol.6(1) 2003:26-29