Immunology and Clinical Importance of Antiphospholipid Antibodies

Author(s):  
H. Patrick McNeil ◽  
Colin N. Chesterman ◽  
Steven A. Krilis
1997 ◽  
Vol 78 (03) ◽  
pp. 1008-1014 ◽  
Author(s):  
Ricardo R Forastiero ◽  
Marta E Martinuzzo ◽  
Graciela S Cerrato ◽  
Lucía C Kordich ◽  
Luis O Carreras

SummaryThe lupus anticoagulant (LA) and anticardiolipin antibodies (aCL) are clinically relevant because of their association with thrombosis and pregnancy loss. The group of antiphospholipid antibodies (aPL) includes antibodies primarily directed against various phospholipid-binding proteins, mainly β2-glycoprotein I (β2GPI) and prothrombin. Some studies suggest that there is an association between the presence of anti β2GPI antibodies (a(β2GPI) of IgG isotype and thrombosis. Therefore, aPL defined according to the plasma protein to which they are directed appear to be more appropriate for the evaluation of their clinical importance. Using home-made ELISAs we evaluated the presence of a(β2GPI and antiprothrombin antibodies (anti-II) of both isotypes (IgG and IgM) in a group of 233 patients with LA and/or aCL. Forty-four women had a history of pregnancy loss, 45 patients had a history of venous thrombosis (VT) and 32 of arterial thrombosis (AT). Patients from the autoimmune group (systemic lupus erythematosus and antiphospholipid syndrome) had a higher prevalence of aβ2GPI and/or anti-II than those from the miscellaneous group. In the univariate analysis, a significant association was shown between the presence of aβ2GPI-IgG (OR 3.2; 95% Cl 1.5-6.6) and previous VT, but not AT. Anti-II were related to VT but the multivariate analysis showed that aβ2GPI-IgG are the only independent risk factor for VT (OR 3.0; 95% Cl 1.3-6.2). The presence of aβ2GPI-IgM correlates well with a history of pregnancy loss (OR 2.6; 95% Cl 1.1-6.1). The coagulation tests profile showed that the clotting assays were more prolonged in patients having aCL, a(β2GPI or anti-II. But a higher prevalence of abnormal results was only found for the dilute Russell viper venom time in patients with VT, as compared to those without thrombosis (94.4% vs. 58.7%, p <0.02). The measurement of aβ2GPI of both isotypes could help to identify aPL-positive patients with a higher risk for thrombosis and pregnancy loss, although this association should be confirmed by prospective studies.


2001 ◽  
Vol 82 (2) ◽  
pp. 107-110
Author(s):  
L. I. Maltseva ◽  
L. A. Lobova

The examination of 167 infected pregnants in I and II terms was carried out to reveal the rate of antiphospholi pid antibodies in pregnants with mycoplasma and associated infection. The pathologic level of anti phospholipid antibodies was determined in 21% of the pregnants with micoplasma and associated infection, in 22% of them the anti phospholipid syndrome was revealed. The most severe complications of pregnancy and accompanied extragenital pathology were found in women with anti phospholipid antibodies. During complex therapy the elimination of antibodies accompanying by the positive clinical dynamics of gestational process was found in some pregnants. Various complications of pregnancy which were arrested by timely treatment were found in women with associated mycoplasma infection without anti phospholipid antibodies.lt is concluded that the formation of anti phospholipid antibodies is the part of infectious process in pregnancy.


Blood ◽  
2001 ◽  
Vol 98 (6) ◽  
pp. 1760-1764 ◽  
Author(s):  
Reyhan Diz-Küçükkaya ◽  
Abdullah Hacıhanefioǧlu ◽  
Mustafa Yenerel ◽  
Mehmet Turgut ◽  
Hüseyin Keskin ◽  
...  

Abstract The pathogenetic role and the clinical importance of the presence of antiphospholipid antibodies (APAs) in patients with immune thrombocytopenic purpura (ITP) are not clear. In this study, the prevalence and clinical significance of APAs were investigated in patients with ITP. Eighty-two newly diagnosed ITP patients were prospectively studied. They were evaluated for the presence of lupus anticoagulant (LA) and immunoglobulin G/M anticardiolipin antibodies (ACAs). Thirty-one patients (37.8%) were APA positive at diagnosis. No statistically significant differences were found between the APA-positive and APA-negative groups regarding gender, initial platelet counts, or response to methylprednisolone therapy. After 5 years of follow-up, cumulative thrombosis-free survival of APA-positive (n = 31) and APA-negative (n = 51) ITP patients was 39% and 97.7%, respectively. A significant difference was found between these groups by log-rank test (P = .0004). In addition, LA was an important risk marker for the development of thrombosis in ITP patients. After a median follow-up of 38 months, 14 ITP patients (45%) who had APA positivity developed clinical features (thrombosis or fetal losses) of antiphospholipid syndrome (APS). There were no differences between the APA-positive patients with and without APS regarding the initial platelet counts, response to the therapy, or ACA positivity. The positivity rate for LA was significantly higher in those patients with ITP who developed APS (χ2: P = .0036; relative risk 7.15; 95% confidence interval, 1.7-47). In conclusion, this study indicates that a significant proportion of patients initially presenting with ITP and APA positivity developed APS. In patients with ITP, the persistent presence of APAs is an important risk factor for the development of APS.


2008 ◽  
Vol 17 (2) ◽  
pp. 43-49
Author(s):  
James L. Coyle

Abstract The modern clinician is a research consumer. Rehabilitation of oropharyngeal impairments, and prevention of the adverse outcomes of dysphagia, requires the clinician to select interventions for which evidence of a reasonable likelihood of a successful, important outcome exists. The purpose of this paper is to provide strategies for evaluation of published research regarding treatment of oropharyngeal dysphagia. This article utilizes tutorial and examples to inform and educate practitioners in methods of appraising published research. It provides and encourages the use of methods of efficiently evaluating the validity and clinical importance of published research. Additionally, it discusses the importance of the ethical obligation we, as practitioners, have to use evidence-based treatment selection methods and measurement of patient performance during therapy. The reader is provided with tactics for evaluating treatment studies to establish a study's validity and, thereby, objectively select interventions. The importance of avoiding subjective or unsubstantiated claims and using objective methods of generating empirical clinical evidence is emphasized. The ability to evaluate the quality of research provides clinicians with objective intervention selection as an important, essential component of evidence-based clinical practice. ASHA Code of Ethics (2003): Principle I, Rule F: “Individuals shall fully inform the persons they serve of the nature and possible effects of services rendered and products dispensed…” (p. 2) Principle I, Rule G: “Individuals shall evaluate the effectiveness of services rendered and of products dispensed and shall provide services or dispense products only when benefit can reasonably be expected.” (p. 2) Principle IV, Rule G: “Individuals shall not provide professional services without exercising independent professional judgment, regardless of referral source or prescription.” (p. 4)


2001 ◽  
Vol 120 (5) ◽  
pp. A386-A386
Author(s):  
K HANADA ◽  
F HINO ◽  
H AMANO ◽  
H OOE ◽  
A HIRAMATSU ◽  
...  

2005 ◽  
Vol 173 (4S) ◽  
pp. 177-178
Author(s):  
Heiko Wunderlich ◽  
Alexander Berndt ◽  
Winfried Hindermann ◽  
Kerstin Junker ◽  
Jörg Schubert ◽  
...  

Author(s):  
Chiara Vari ◽  
Patrizia Velotti ◽  
Alessandro Crisi ◽  
Silvana Carlesimo ◽  
Antonio G. Richetta ◽  
...  

Abstract. A broad range of literature reported higher rates of psychopathology and personality disorders among patients affected by skin conditions. Specifically, depression, anxiety, and suicidal ideations are more frequently reported by patients affected by skin diseases. This study aimed to examine psychopathology and personality in a group of patients affected by psoriasis by means of a self-report measure (Millon Clinical Multiaxial Inventory – MCMI-III) and a performance-based technique (Wartegg Drawing Completion Test [WDCT], CWS). Study results showed a higher rate of passive-aggressiveness and paranoia among psoriatic patients (MCMI-III). When assessing patients through the performance-based technique (WDCT, CWS), a higher rate of global rejection (GR) – linked by previous literature to suicidal ideation – and a lower affective quality of the drawings emerged. We discuss the clinical importance of detecting psychological issues in dermatology patients by means of a multimethod assessment that goes beyond patients’ self-evaluation of their symptoms and emotions.


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