Transient lupus anticoagulant: an unusual cause of bruising in children

Abstract

A child presented with excessive bruising and prolonged activated partial thromboplastin time. Mixing studies in plasma were positive for phospholipid dependence of the anticoagulant, confirming a diagnosis of lupus anticoagulant. Factor II level was reduced. Laboratory findings normalised after three months, with spontaneous resolution of bruising. This case demonstrates a transient antiphospholipid antibody syndrome as a rare presentation of bleeding diathesis in a previously healthy child, and should be considered in children with new onset bruising and prolonged activated partial thromboplastin time.

Lupus anticoagulant acquired hypoprothrombinemia syndrome in childhood: two distinct patterns and review of the literature

“…A total of 34 articles including case reports, case series and letters to editors between 1960 and 2014 were reviewed ( Table 2) [1][2][3][4][5][6][7][8][9][10][11][12][13]15,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Fifteen case reports [6,8,13,[17][18][19][20][21][22][26][27][28][29][30]36] and 5 case series [1,...…”

Rare Bleeding Disorders in Children: Identification and Primary Care Management

“…66 Correction of APTT or of another phospholipid-based screening test, the dilute Russell viper-venom time, after the addition of a phospholipidrich source (eg, platelets in the platelet neutralization procedure) confirms the presence of a lupus anticoagulant. 63,66 If testing for a coagulation factor inhibitor is indicated based on clinical grounds or negative lupus anticoagulant testing, the coagulation factors of interest can be narrowed down on the basis of the uncorrected coagulation study (Fig 1).…”

“…Conversely, a lack of or partial correction in a mixing study suggests the presence of a specific or nonspecific coagulation factor antibody (inhibitor). Nonspecific inhibitors include lupus anticoagulants, which may occur transiently in children (eg, after viral illness), 66 are typically asymptomatic, 66 and tend to be the most common cause of a prolonged APTT in nonbleeding children. Specific coagulation factor inhibitors are far less common in children, even less common than most RBDs.…”

Bruising in a child after a viral illness

“…It often presents immediately following a viral illness or a new medication. Although hemorrhagic symptoms are only estimated to occur between 10%–20% of patients with lupus anticoagulant, 2 it can be the first presenting symptom and should be considered in children with spontaneous bruising 1,3 . Because of the diffuse, large areas of ecchymosis that may occur in this disease process, ingestion, thrombotic thrombocytopenic purpura, leukemia, and non‐accidental trauma must all be considered in the differential diagnoses in a child with these physical examination findings in the acute emergency setting.…”