Lupus anticoagulant and anticardiolipin antibodies in an obstetric population

Abstract

Lupus anticoagulant (LA) and anticardiolipin antibodies (ACA) have been reported to be associated with fetal loss. OBJECTIVE. Our aim was to estimate the incidence of LA and to examine the correlation between LA and ACA in pregnant women. To investigate the clinical significance of LA and ACA in an obstetric population. STUDY DESIGN. A prospective, cross sectional study of 2856 consecutive women admitted to a department of obstetrics and gynecology for delivery or due to pregnancy complications during an 11 month period. METHODS. Activated partial thromboplastin time (APTT) was determined in all patients. LA and ACA were determined if APTT > or = 35 sec. For reference ACA was determined in a group of randomly selected patients with APTT < 35 sec. The results were analyzed in relation to the obstetrical records. RESULTS. Overall incidence of APTT > or = 35 sec.: 7.0%, significantly more frequent in patients with early spontaneous abortion (18.6%) and intrauterine growth retardation (17.5%). Incidence of LA 0.07%. The patients had undetectable ACA and no clinical condition related to LA. Incidence of ACA class IgM (IgM-ACA) in patients with APTT > or = 35: 20.4%, significantly higher than in the reference group (9.6%). Uncomplicated pregnancy in 84% of patients with IgM-ACA. No cases of ACA class IgG (IgG-ACA) in patients with APTT > or = 35 but two cases in the reference group (one normal pregnancy, one spontaneous abortion). CONCLUSION. LA is a rare manifestation with uncertain significance in otherwise healthy pregnant women. IgM-ACA in low titer occurs relatively frequently during normal pregnancy.

Antiphospholipid Antibodies: A Critique of Their Heterogeneity and Hegemony

“…ACAs are detected in 30 to 40% of pregnant women with SLE. [78][79][80][81][82][83][84][85][86] The risk of recurrent spontaneous abor tion (RSA), fetal loss, prematurity, and intrauterine growth retardation is significantly increased in this popu lation if untreated; treatment reduces fetal loss in identi fied, high-risk pregnancies. 46 ' 78 ' 79 Advantages and dis advantages of steroid and anticoagulant treatment programs are still being weighed.…”

“…85 In one obstet ric study, IgG and IgM PSA were elevated in 87% and 40%, respectively, of samples compared with 68% IgG ACAs and 36% IgM ACAs; patients with low amounts of IgM ACAs had successful pregnancies in 84% of women in the study. 86 Most fetal loss in patients with ACA is attributed to placental vascular destruction and infarc tion 83 rather than immune-precipitated thrombotic epi-sodes in the fetus. 88 A case of neonatal thrombosis in association with ACAs in baby and mother was reported.…”

A re‐appraisal of the normal cut‐off assignment for anticardiolipin IgM tests

“…A few studies have examined the prevalence of ACA in the ‘normal’ population and the significance of low titers [33–35]. These studies indicate the prevalence of ACA in normal individuals with no association with clinical symptoms of APS [36–40]. In particular, reports from different laboratories show an apparent large number of normal individuals with low to moderate titers of ACA of the IgM isotype [37–40].…”

Clinico-genealogical investigation of antiphospholipid syndrome

“…Распространенность волчаночного антикоагулянта среди здоровых лиц составляет, по результатам разных исследований, от 0 до 4% (в среднем 1-2%) [13,18,22,24] и с возрастом может увеличиваться до 5% [5]. ВА среди обследованных нами родственников встречался у 39,1%, то есть с частотой, превышающей в десятки раз среднепопуляционную, что, вероятно, может свидетельствовать о наследуемой природе данного коагуляционного феномена.…”