Successful Delivery in a Pregnant Woman with Lupus Anticoagulant Positive Systemic Lupus Erythematosus Treated with Double Filtration Plasmapheresis

Abstract

The case was a 29 year old female who has suffered from systemic lupus erythematosus (SLE) since 15 years of age. The activity of SLE was low, and she took prednisolone orally. Her first pregnancy failed after 14 weeks. In the second pregnancy, she had thrombocytopenia, prolonged activated partial thromboplastin time (APTT), positive lupus anticoagulant (LAC) and thus was diagnosed with antiphospholipid antibody syndrome (APS). Combination therapy with steroids and aspirin was started, and she underwent treatment of double filtration plasmapheresis (DFPP) in the early stage of pregnancy. Her platelet count increased, and the value of APTT has normalized with DFPP treatment. She delivered successfully on the 32nd week of pregnancy. We think that DFPP is an effective and safe treatment in patients with an LAC positive pregnancy.

Plasmapheresis and pregnancy outcome in patients with antiphospholipid syndrome

“…However, in autoimmune diseases, plasmapheresis may lead to a rebound overproduction of the same antibodies and require intensified treatment [7]. Similar results were obtained in the report by Takeshita et al [11]. They started a combination therapy of steroids and aspirin, as well as double filtration plasmapheresis, in the early stage of pregnancy in a patient with APS.…”

“…Because plasmapheresis physically removes antibodies and their end products it has been used for successful treatment of several conditions including HELLP syndrome, thrombotic thrombocytopenic purpura, cryoglobulinemia [7], and catastrophic APS [8]. Several case reports have suggested that plasmapharesis may also be a successful treatment for pregnant women with APS [9–11].…”

Long-term efficacy of immunoadsorbent plasmapheresis in a patient with Budd-Chiari syndrome due to antiphospholipid syndrome: case report with nine-year follow-up

“…The ef cacy of DFPP in pregnant women with APS 14 and noncatastrophic APS 15 has already been described. Not only the level of aCL but also that of LAC will be expected to diminish with DFPP and the short-term ef cacy of DFPP will be superior to that of IAPP in this regard.…”