Detection of Lupus Anticoagulant In Women with Obstetric complications

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3185-3185
Author(s):  
Andrea Laura Avigliano ◽  
Juan Carlos Galli ◽  
Beatriz Grand
Keyword(s):  
Lupus Anticoagulant ◽  
Conflicts Of Interest ◽  
Fetal Loss ◽  
Negative Control ◽  
Screening Tests ◽  
Initial Cohort ◽  
Uterine Growth ◽  
Confirmatory Tests ◽  
History Of ◽  
Low Performance

Abstract Abstract 3185 Introduction: Lupus anticoagulant (LA) is one of the laboratory criteria for the diagnosis of antiphospholipid syndrome. To detect the presence of LA, ISTH recommends performing two assays based on different principles. Our LA profile includes dilute Russell viper venom time (dRVVT) and two different activated partial thromboplastin time (aPTT) reagents. The aim of the study was to evaluate sensitivity and specificity of aPTT and dRVVT in women with a history of pre-eclampsia, intra-uterine growth restriction, early recurrent abortion, late fetal loss and placental abruption collectively termed “placenta mediated complications”. Materials and Methods: We studied a total of 247 patients and 287 samples in a 10 months period. Based on consensus criteria, samples were retested within a period of three months. 62/247 plasmas samples were collected during pregnancy. Laboratory studies: Screening tests: aPTT was performed using PTT-LA (Stago) and an aPTT home made reagent with diluted cephalin. dRVVT was performed using Russel viper venom RVV (Stago) and diluted cephalin. Negative control plasma was prepared according to ISTH LA recommendations for the mixing tests. Confirmatory tests: We performed a home made reagent for platelet neutralization procedure (PNP)-aPTT and dRVVT; Rosner Index and % of Correction as criteria for mixing and confirmatory tests interpretation. Statistical evaluation was performed by ROC method using EP Evaluator 9.9 software. Results: 172/287 samples (59.9%) were negative, while 115/287 samples (40.1%) were positive for LA. 44/115 samples (38.26%) were positive for both tests (aPTT and dRVVT), 60/115 samples (52.17 %) were positive only for dRVVT and 11/115 samples (9.57%) were positive only for aPTT. LA was confirmed in 9/62 pregnant women samples (14.5 %). 7 (11.3%) had abnormal dRVVT, the remaining 2 samples were positive for both tests. Conclusions: Our results demonstrated: 1- High prevalence of dRVVT positive plasmas 104/115 (90.43%); 2- Despite showing a low performance regarding sensitivity when compared to dRVVT, both aPTT tests were able to detect LA in 47.83% of the positive studies. 3- According to our experience, considering this initial cohort of selected patients, the use of dRVVT as the first and aPTT as the second screening test may help improve the performance for the diagnosis of LA. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Antiphospholipid Antibodies in Iraqi Women with Recurrent Mid-Trimester Abortions

2012 ◽  
Vol 4 (02) ◽  
pp. 078-082
Author(s):  
Amel AA Al-Samarrai ◽  
Ferial A Hilmi ◽  
Nasir AS Al-Allawi ◽  
Amal F Murad
Keyword(s):  
Family History ◽  
Antiphospholipid Antibodies ◽  
Lupus Anticoagulant ◽  
Fetal Loss ◽  
Anticardiolipin Antibodies ◽  
Screening Tests ◽  
Trimester Abortion ◽  
History Of ◽  
Iraqi Women ◽  
Kaolin Clotting Time

ABSTRACT Purpose: Antiphospholipid antibodies are often associated with recurrent pregnancy loss, and although many studies have addressed this association in Western countries, such studies are not so frequent from developing countries. The current study aims to determine the frequency of Antiphospholipid antibodies (Anticardiolipin antibodies and Lupus anticoagulant) among Iraqi women with recurrent mid-trimester abortions and to evaluate various tests used for their detection. Materials and Methods: Two hundred women with recurrent mid-trimester abortions were randomly enrolled from a main referral center in Baghdad-Iraq. The enrollees had their IgG and IgM anticardiolipin antibodies assayed by ELISA, and Lupus anticoagulant by a combination of the following screening tests: Activated Partial Thromboplastine Time (APTT), and Partial Thromboplastine Time-LA (PTT-LA), Kaolin Clotting Time (KCT) and confirmation was made by Hexagonal phospholipid neutralization test. Results: The women were aged between 19 and 45 years (median 30 years). Fifty three (26.5%) had one or both anticardiolipin antibodies present, while 27 (13.5%) were positive for lupus anticoagulant. The KCT and KCT index appeared to be the most sensitive tests, while the KCT index and APTT were the most specific for Lupus anticoagulant. Patients with antiphospholipid antibodies had higher rates of history of thrombosis, thrombocytopenia and family history of recurrent abortion (P = 0.0009, 0.0056 and 0.0003 respectively). Conclusions: Antiphospholipid antibodies constitute an important cause of recurrent mid-trimester abortion in Iraqi women, with frequencies intermediate between Western and Indian reports. While thrombocytopenia and thrombosis are well documented associations of antiphospholipid antibodies, the significant association with family history of recurrent fetal loss is intriguing and requires further scrutiny.

The Influence of Antiphospholipid Antibodies on the Pregnancy Outcome of Patients With Recurrent Spontaneous Abortion

2001 ◽  
Vol 7 (4) ◽  
pp. 281-285 ◽  
Author(s):  
L. Heilmann ◽  
G.-F. v. Tempelhoff ◽  
S. Kuse
Keyword(s):  
Pregnant Women ◽  
Intravenous Immunoglobulin ◽  
Spontaneous Abortion ◽  
Antiphospholipid Antibodies ◽  
Lupus Anticoagulant ◽  
Standard Therapy ◽  
Loss Rate ◽  
Fetal Loss ◽  
Negative Group ◽  
History Of

Several therapeutic regimens have been proposed for women with recurrent spontaneous abortion (RSA) and antiphospholipid antibodies (APA). Conflicting results have been reported about women with history of RSA, positive APA, and failure of standard therapy. To evaluate the use of intravenous immunoglobulin in RSA patients with APA and history of treatment failure, we initiated a study with standard therapy (aspirin and low-molecular- weight heparin) and intravenous immunoglobulin. We used an enzyme-linked immunosorbent assay (ELISA)test to screen IgG and IgM anticardiolipin antibodies, and a diluted Russel viper venom time assay for the lupus anticoagulant activity. Altogether. 66 pregnant women with positive APAs at the first visit could be included. Patients with hereditable thrainbaghilic factors were excluded. After confirmation of the pregnancy, women received a basis immunization of 0.3 g/kg immunoglobulin in a 4-week cycle until the 28th to 32nd week of gestation. All patients received 100 mg/d aspirin and 3,000 anti-Xa U/d certoparin. Among the 66 pregnant women, 17 were persistently autoantibody positive (25.8%), of whom 11 (16.7%) were ACA positive alone, 2 (3%) were lupus anticoagulant positive, and 4 (6.4%) had both antibody types. A total of 49 patients had positive APAs at the initial test, but were negative for ACA and lupus anticoagulant at the second test administered approximately 5 weeks after the start of therapy. We described this group in our following observation as "antibody negative." Sixteen of the 17 autoantibody-positive patients (94.1 %) were delivered of live infants compared with 40 patients (81.6%) in the antibody-negative group (odds ratio [OR]: 1.2; 95% CI: 0.98 to 1.4). The overall miscarriage rate was 12.1% and the fetal loss rate was 15.2%. Four patients (25%) in the antibody-positive group developed symptoms of preeclampsia and fetal growth retardation compared with four patients (9.8%) in the antibody-negative group. In conclusion. we see a reduction of the fetal loss rate in patients with RSA and positive APA (5.8%) compared with APAnegative (18.4%) women with the same therapy (OR: 0.3; 95% CI: 0.04 to 2.3).

Clinical and Economic Impact of Pre-Operative Coagulation Screening in Children

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3379-3379
Author(s):  
Trishala Agrawal ◽  
Louisa Mazza-Hilway ◽  
Alice J. Cohen ◽  
Sari H Jacoby
Keyword(s):  
Family History ◽  
Major Bleeding ◽  
Conflicts Of Interest ◽  
Personal History ◽  
Screening Tests ◽  
Factor Vii ◽  
Factor Xii ◽  
Coagulation Tests ◽  
History Of ◽  
The Mean

Abstract Abstract 3379 Background: The literature in the past has recommended pre-operative (PRE-O) coagulation screening only when indicated by history or physical exam. Despite these recommendations, surgeons continue to order PT and PTT prior to surgery, especially in children, because they have often not been hemostatically challenged. We evaluated the usefulness of screening tests in identifying significant bleeding risk and associated cost. Methods: We performed a retrospective audit on children referred to the hemophilia center sent for further evaluation of abnormal PT and PTT on PRE-O screening. We reviewed 62 patients who had 80 procedures, out of which 70 procedures were evaluable with complete data. Age, personal and family history of bleeding, coagulation tests, PRE-O and post-operative (PO) treatment, and immediate PO bleeding were assessed. Results: The most common procedure that led to PRE-O screening was tonsillectomy/adenoidectomy at 61% (49/80). Other procedures included orthopedic, GI, oral, dental extractions, and myringotomies. Only 2.5% (2/80) were cardiac procedures. The mean patient age was 6 years (range 1–16). 55% (34/62) had no personal or family history of bleeding. 22.5% (14/62) had a family history of mild bleeding such as epistaxis or menorrhagia. 8% (5/62) had a family history of major bleeding disorders such as Von Willebrand disease (VWD) or hemophilia. 14.5% (9/62) had a personal history of bleeding, mild or major. The most common abnormal screening test was the PT at 40% (25/62). 27% (17/62) had an abnormal PTT (3.2% \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(262\) \end{document} with a significantly abnormal PTT above 50). 22.5% (14/62) were referred for abnormal PT/PTT. 8% (5/62) with an abnormal PT and/or PTT corrected on repeat studies. The remaining 9.6% (6/62) were referred for other reasons such as positive family or personal history and a high risk procedure. Additional coagulation tests ordered because of prolonged PT or PTT varied and included additional factor assays (Table 1). The mean cost of additional testing was >$1000. Factor VII was the most common factor deficiency identified with a mean activity of 47% (27–54%) (normal 55–163%) followed by factor XII deficiency with a mean activity of 39% ( 19–49%) (normal 46–168%). PRE-O, 5 patients received support with either Humate P, Stimate, Amicar, or DDAVP, 4 with a diagnosis of VWD and 1 with Jacobsen Syndrome; 3 of these patients received PO Amicar. PO, 69/70 procedures were completed with minimal (2–45 mL) bleeding. Only 1/70 procedures had significant PO bleeding, despite normal tests. This patient did not have any significant immediate PO bleeding, but had delayed bleeding reported at day 7 requiring cauterization. No other cases of delayed PO bleeding were reported to our clinic. Conclusion: In patients who undergo routine screening by laboratory testing only, the most common abnormality found was a prolonged PT. Subsequent workup of patients with abnormal screening tests identified factor VII or factor XII deficiencies most frequently. Only one patient with abnormal PT/PTT was diagnosed with a significant bleeding disorder, VWD. Major bleeding occurred rarely. This study demonstrates that the cost of extensive PRE-O coagulation testing is high with minimal clinical impact. Disclosures: No relevant conflicts of interest to declare.

Management Of Pregnancy In Patients With Antithrombin Deficiency

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 216-216
Author(s):  
Mario von Depka ◽  
Stefanie Döpke ◽  
Anja Henkel-Klene ◽  
Cornelia Wermes ◽  
Mahnaz Ekhlasi-Hundrieser ◽  
...  
Keyword(s):  
High Risk ◽  
Pregnancy Loss ◽  
Conflicts Of Interest ◽  
Fetal Loss ◽  
Bleeding Complications ◽  
Thromboembolic Events ◽  
Increased Risk ◽  
History Of ◽  
At Deficiency ◽  
The Mean

Abstract Introduction During pregnancy women have a four- to five-fold increased risk of thromboembolism (TE) compared to women who are not pregnant. Among the most important risk factors for TE in pregnancy is the presence of thrombophilia. Multiple reports have described an association between antithrombin (AT) deficiency and an increased rate of thromboembolic events especially during pregnancy. As the placental development depends on well-balanced pro- and anticoagulant mechanisms, thrombophilia, e.g. AT deficiency may be associated with poor pregnancy outcome. Despite anticoagulation with low molecular weight heparin (LMH) during pregnancy and the postpartum period alone, women with AT deficiency are still at a high risk to develop TE, especially perinatal and during puerperium because of withheld anticoagulation to prevent bleeding complications. Therefore, several guidelines recommend the administration of antithrombin concentrates during high risk situations as pregnancy. Here, we present the results of our study on the usage of AT concentrates in pregnant women with AT deficiency who either suffered from fetal loss or thromboembolism prior inclusion. Methods In total, 22 pregnancies in 19 patients (age: 31.9±4.7; 22-41) with AT deficiency were included in this open-label, single-center study. Ten patients (53%) had a history of fetal loss, 9/19 (47%) patients hat a history of thromboembolism. During all pregnancies AT concentrate (AT-C) was administered, in 18/22 (81.8%) pregnancies LMH was given in addition. Prior pregnancy losses (21/30, 70%) occurred in all trimester (t1: n=11, t2: n=5, and in t3: n=5). Historical live birth rate (LBR) was 30%. Blood samples were collected in all trimesters and postpartum to analyze AT activity and antigen, endogenous thrombin potential (ETP), thrombin-antithrombin-complex (TAT), Fragment 1+2 (F1+2) and c-reactive protein test (CRP). A total of 114 uneventful pregnancies of 113 healthy women served as controls. Furthermore, the mean doses of AT concentrates/kg BW and the mean total number of infusions were calculated. Results In total, 21 pregnancies (95.5%) were successful. Mean total requirement of AT concentrate per pregnancy was 79.454 IU (range: 3.000-272.000 IU) during 27.8 treatment days per pregnancy (range: 1-88). Our data show an increase of F1+2 in the course of pregnancy. Mean levels of F1+2 at t1, t2 and t3 (t1= 255.9 ± 107.6, t2= 360.9 ± 117.4, t3= 545.3 ± 220.3 pmol/L) were significantly higher than in controls (t1= 82.2 ± 43, t2= 140 ± 100.2, t3= 183.5 ± 103.1, p<.001). Mean level of TAT was higher (3.1 ± 1.4 ng/mL) than in controls (1.7 ± 1.6 ng/mL, p=.001) in t1, whereas mean TAT in t2 and t3 was lower than in controls (3.8 ± 1.3 vs. 4.8 ± 1.9, p=.03; 5.0 ± 1.4 vs. 6.1 ± 3.0 ng/mL, n.s., resp.). No thromboembolic events occurred. In patients receiving AT-C, LBR increased from 30% to 95.5% (p<0.001) with a relative risk of 49.0 to develop pregnancy loss without anticoagulant treatment (5.7 – 421.8; 95% CI). Conclusion In patients with AT deficiency receiving AT concentrate and LMH we could demonstrate a significant increase of LBR from 30% to 95.5%. Furthermore, no thromboembolic events occurred, though almost half of the patients had a history of thromboembolism. There was no clear evidence of increased hypercoagulability. We conclude that combined AT concentrate and LMH are safe and efficacious for mother and child in preventing thromboembolism and pregnancy loss. Further studies to evaluate the exact mode of anticoagulation and benefit of combining AT concentrate and LMH are warranted. Disclosures: No relevant conflicts of interest to declare.

Primary Thrombophilia in Mexico XII: Miscarriages Are More Frequent in Persons with the Sticky Platelet Syndrome (SPS)

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4937-4937
Author(s):  
Guillermo J Ruiz-Delgado ◽  
Yahveth Cantero-Fortiz ◽  
Mariana Méndez-Huerta ◽  
Mónica León-González ◽  
Andrés A. León-Peña ◽  
...  
Keyword(s):  
General Population ◽  
Venous Thrombosis ◽  
Conflicts Of Interest ◽  
Fetal Loss ◽  
Obstetric Complications ◽  
Obstetric Outcomes ◽  
Single Institution ◽  
Clinical Marker ◽  
Female Patients ◽  
History Of

Abstract Background: The sticky platelet syndrome (SPS) is an inherited condition which leads into arterial and venous thrombosis. There is scant information about the association between the SPS and obstetric complications. Objective: To assess the relationship of the SPS and fetal loss in a single institution. Material and methods: The obstetric history of all the consecutive female patients prospectively studied along a 324 month period, in a single institution with a history of thrombosis and a clinical marker of primary thrombophilia was reviewed. Results: Between 1989 and 2016, 268 consecutive patients with a clinical marker of primary thrombophilia and a history of arterial or venous thrombosis were studied; of these, 108 were female patients. Within this subset, 77 (71%) had been pregnant at some moment. Twenty eight of these 77 patients (37%) had had an abortion and 24 out of these (86%) were found to have the SPS. On the other hand, in a subset of 73 female patients with the SPS who had been pregnant, 32% had miscarriages (14 had one abortion, 5 two abortions and 4 three or more abortions). These figures are significantly higher than the prevalence of abortions in the Mexican general population of pregnant women, which is 12-13% (chi square = 7.47; p = 0.0063). Accordingly, the relative risk of having a miscarriage is 2.66 times higher in female patients with the SPS than in the general population (p = 0.0014 ). Conclusion: In México, female patients with the SPS experience significantly more miscarriages than the general population. Since the treatment of the SPS is simple and effective and could in turn prevent adverse obstetric outcomes, its investigation in women studied because obstetric complications may be useful and deserves further research. Disclosures No relevant conflicts of interest to declare.

Application of Thrombomodulin-Thrombin Generation to Diverse Abnormalities of the Protein C System

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 31-32
Author(s):  
Marilyn J Manco-Johnson ◽  
Linda Jacobson ◽  
Dianne Thornhill ◽  
Christine Baird ◽  
Beth Boulden Warren
Keyword(s):  
Family History ◽  
Lupus Anticoagulant ◽  
Protein C ◽  
Thrombin Generation ◽  
Conflicts Of Interest ◽  
Positive Family History ◽  
Factor V Leiden ◽  
Healthy Controls ◽  
Blood Draw ◽  
History Of

Background: Increased thrombin generation is an interesting candidate as a potential indicator of hypercoagulability and thrombosis risk. Increased thrombin generation using the calibrated automated thrombogram (CAT) has been reported in antithrombin deficiency but the CAT does not reflect protein C deficiency without the addition of thrombomodulin (TM). TM activates protein C (PC) in the CAT and reduces thrombin generation. Objective: The objective of this study was to determine the capacity of the TM-augmented CAT to detect defects in various protein C system components; the lupus anticoagulant was also investigated as a cause of decreased protein C activation. Methods: The CAT-TM was performed with reagents and methods per the manufacturer's instructions using 5 pM tissue factor and TM (Stago). Other assays included: PC (chromogenic), free protein S (PS, LIA), activated protein C resistance (aPTT-based clotting assay), factor V Leiden (FVL PCR) and lupus anticoagulant (LA, dRVVT and Staclot LA, Stago). Platelet poor plasma samples were obtained from the biobank of a consented prospective inceptional cohort study of thrombosis and thrombophilia or a positive family history of either (ThromboPICS #05-0339); samples from healthy controls with no personal or family history of thrombosis or thrombophilia were collected on a consented protocol (#09-0816). Samples from participants on therapeutic inhibitors of factor Xa or thrombin were treated with appropriate neutralizers; no sample was tested on warfarin. Clinical data included gender, age (&lt; 18 versus ≥ 18 years), history of thrombosis, timing of sample from most recent thrombosis (acute &lt; 14 days; subacute 14-90 days; or chronic &gt; 90 days) and use of anticoagulants at the time of the blood draw. Tests for violations of normality were negative. Therefore, results of cohorts versus controls were compared with independent sample t-test and subgroup analyses relative to control used One-Way ANOVA. Post-hoc comparisons of each subgroup to the controls were collected for multiple comparisons using the Bonferroni correction. Results: Ninety-nine cases and 45 normal controls were studied. Overall half of the cases had a history of thrombosis and 66% of those with thrombosis were on no anticoagulation at the time of testing. Table 1 displays results of the CAT-TM in the 2 control and 6 study groups. Control adults and children showed a mean 50% thrombin reduction in thrombin generation with CAT-TM; overall, persons with protein C system defects showed approximately 25% reduction, with the least reduction of thrombin generation in the cohort of PC deficiency at 19%. Sensitivity of the CAT-TM was 100% for PC deficiency, 81% for LA positivity, 80% for PS deficiency and 72% for FVL positivity with no difference in degree of thrombin reduction between hetero- and homozygous FVL. In addition, we identified 14 individuals with CAT-TM results similar to protein C system defects but with confirmed normal PC, PS, FVL and LA tests. Although 9 of these unknowns had a personal (7) or family (2) history of thrombosis, five came from the healthy controls. The false positive results in 3 adult and 2 pediatric controls conferred a CAT-TM test specificity of 89%. Furthermore, analyses showed no differences in CAT-TM results related to gender, age group, history of thrombosis, age of clot at blood draw (acute, subacute or chronic) or use of anticoagulation at the time of blood draw. Conclusions: The CAT-TM is a useful screening test for defects in the protein C system, including LA, although this test could not discriminate between heterozygous and homozygous FVL. The etiology of positive CAT-TM in normal individuals or individuals with a personal or family history of thrombosis without identified PC system defects is currently unknown and under ongoing investigation. Disclosures No relevant conflicts of interest to declare.

Relationship between lupus anticoagulant (LAC) and pregnancy-induced hypertension

1995 ◽  
Vol 7 (6) ◽  
pp. 1569 ◽  
Author(s):  
T Matsumoto ◽  
N Sagawa ◽  
Y Ihara ◽  
F Kobayashi ◽  
H Itoh ◽  
...  
Keyword(s):  
Lupus Anticoagulant ◽  
Fetal Loss ◽  
Systemic Autoimmune Disease ◽  
Pregnancy Induced Hypertension ◽  
Induced Hypertension ◽  
History Of ◽  
Group A ◽  
Coagulation Assay ◽  
Group B

Lupus anticoagulant (LAC), a serum antiphospholipid autoantibody, is believed to be one of the causes of infertility or fetal loss. The purpose of the present study was to evaluate the role of LAC in the pathogenesis of hypertension during pregnancy. In this study, 20 pregnant women with hypertension were classified into two groups: 14 patients who did not have hypertension before the pregnancy but developed it during the pregnancy (pregnancy-induced hypertension; Group A) and 6 patients who had hypertensive or renal disease before the pregnancy, and developed further hypertension during the pregnancy (pregnancy-aggravated hypertension; Group B). A LAC coagulation assay was performed, and the presence of LAC in each group was compared. All 14 patients in group A were LAC-negative. In contrast, 3 of the 6 patients in group B were LAC-positive, and had clinical autoimmune diseases. The incidence of pregnancy-induced hypertension was also examined in 15 pregnancies from 9 LAC-positive women who had a history of repeated fetal loss but no systemic autoimmune disease (Group C). None of these 15 pregnancies had hypertensive complications, even when they reached term. In the placentas of LAC-positive women, no characteristic changes other than fibrinoid degeneration and microscopic infarction were observed upon histological examination. These results suggest that LAC does not relate with the onset of hypertension during pregnancy.

Comparison of aPTT (Platelin LS®) and Dilute Russell’s Viper Venom (Viperquik LA Test®) for the Screening of Lupus Anticoagulant in Patients with Venous Thromboembolism.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4122-4122
Author(s):  
Celso A. Roprigues ◽  
Aline A. Martinez ◽  
Vania M. Morelli ◽  
Raniely C. Silveira ◽  
Maria Aparecida E. Noguti ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Partial Thromboplastin Time ◽  
Lupus Anticoagulant ◽  
Activated Partial Thromboplastin Time ◽  
Screening Tests ◽  
Clotting Time ◽  
Substantial Agreement ◽  
Confirmatory Tests ◽  
Russell’S Viper ◽  
Rule Out

Abstract INTRODUCTION: To rule out the presence of LA antibodies, two or more assays that are sensitive to these antibodies must be negative. The dilute Russell’s Viper Venom Time (dRVVT) and the activated partial thromboplastin time (aPTT) using sensitive reagents have been employed to detect LA. The aim of this study was to assess the concordance level of aPTT using Platelin LS and dRVVT as screening tests to identify LA in patients with venous thromboembolism (VTE). METHODS: 94 patients (58 women, 62%) with VTE were evaluated. The detection of circulating inhibitor with Platelin LS and dRVVT was based on a prolonged clotting time and a prolonged 1:1 mixture of sample plasma and normal pooled plasma. The confirmation of the phospholipid dependency was performed only with dRVVT. RESULTS: Among the 94 patients, an abnormal test was found in 24 patients (26%) with aPTT and in 61 patients (65%) using dRVVT. After mixing tests, aPTT ratio remained long in 25% of patients with abnormal aPTT, and in 9.8% with long dRVVT. Five patients had a prolonged mixing study identified by both tests, which resulted in a substantial agreement between the two tests (Kappa= 0.78). Confirmatory tests for LA were positive in 5 out of the 6 patients with long dRVVT mixture, resulting in a prevalence of LA detected by dRVVT of 5.3%. The 5 patients with LA detected by dRVVT also had prolonged mixture with aPTT. CONCLUSION: Our results indicate that aPTT with Platelin LS is highly associated with the presence of LA detected by dRVVT and may be suitable as a screening test for LA in patients with VTE.

Serial D-Dimer in Pregnancy Women with a History of Fetal Loss Syndrome and Invitro Fertilization

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4366-4366
Author(s):  
Tubagus Djumhana Atmakusuma ◽  
Raden Muharam
Keyword(s):  
Pregnant Women ◽  
Umbilical Artery ◽  
Conflicts Of Interest ◽  
Post Partum ◽  
Fetal Loss ◽  
Assay Method ◽  
Chromogenic Assay ◽  
History Of ◽  
High Level ◽  
D Dimer

Abstract Abstract 4366 Background We have reported in abstract P-Th-374 in a 2011 Kyoto ISTH Congress that an increased level of D-dimer in combination with umbilical artery systolic diastolic (UASD) ratio can be used as a timing to start with prophylactic anticoagulants In women with pregnancy failure, regardles of the antibody antiphospholipids (APAs) level, history of fetal loss syndrome or invitro fertilization (IVF). The question is: Are there any differences of a serial D-dimer level if is compared to the APAs level, history of fetal loss syndrome and IVF?. Methods. A retrospective Cohort study was conducted on a total sampling subjects of pregnancy women who visited two hospitals in Jakarta, Indonesia, at a periode of January 2009 – December 2010. Serial D-dimer using chromogenic assay method (cut off normal level < 500 ng/ml) was tested during antenatal and post partum period. The data were analysed to compare a mean D-dimer with the level of APAs (ACA IgG/IgM, AntiB2GP1 IgG/IgM) tested using ELISA method, a history of fetal loss syndrome and IVF conception Results Of 83 pregnant women,19 women with high level of APAs (subgroup 1) showed a mean D-dimer level as follows: Trimester I: 892.15 ± 785.15 ng/ml, trimester II: 782.59 ± 440.53 ng/ml, trimester III:1282.62 ± 601.22 ng/ml, post partum 1367.45 ± 581.19 ng/ml; 31 women with normal APAs (subgroup 2) showed: Trimester I: 666.23 ± 396.24 ng/ml, trimester II: 896.66 ± 396.24 ng/ml, trimester II: 896.66 ± 496.32 ng/ml, trimester III: 1313.45 ± 850.20 ng/ml, post partum: 1991.75 ± 1388.70 ng/ml; 33 women with no data of APAs (subgroup 3) showed: Trimester I: 568.47 ± 482.70 ng/ml, trimester 2: 797.95 ± 934.59 ng/ml, trimester III: 966.89 ± 862.10 ng/ml, post partum: 1078.50 ± 836.29 ng/ml Of 83 pregnant women, 47 women who have experienced 1 or ≥ 1 abortion or IUFD (subgroup 4) showed D-dimer level as follows: Trimester I:493.09 ± 385.89 ng/ml, trimester II: 740.23 ± 564.99 ng/ml, trimester III: 859.05 ± 549.88 ng/ml, post partum 1342.59 ± 1264.09 ng/ml. Meanwhile, 36 women who have no history of fetal loss (subgroup 5) showed: Trimester I: 892.17± 593.47 ng/ml, trimester II: 930.57± 807.02 ng/ml, trimester III: 1439.71 ± 932.12 ng/ml, post partum 1695.16 ± 1131.56 ng/ml. Of 83 pregnant women, 10 women who became pregnant after embryo transfer of IVF (subgroup 6) showed: Trimester I: 493.09± 385.895 ng/ml, trimester II: 740.23± 564.99 ng/ml, trimester III:859.05 ± 549.88 ng/ml, post partum 1342.59 ± 1264.09 ng/ml. Conclusion Either in subgroup 1, 2, 3,4,5 and 6 mean D-dimer tend to increase from trimester I to trimester II and from trimester II to trimester III, except in subgroup 1 from trimester I to trimester II of pregnancy. Meanwhile, all groups showed a higher mean D-dimer post partum compared to antenatal period. Disclosures: No relevant conflicts of interest to declare.

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