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van Dijk MM, Vissenberg R, Bisschop PH, Dawood F, van Wely M, Goddijn M, Farquharson RG. Is subclinical hypothyroidism associated with lower live birth rates in women who have experienced unexplained recurrent miscarriage? Reprod Biomed Online 2016; 33:745-751. [DOI: 10.1016/j.rbmo.2016.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 09/11/2016] [Accepted: 09/12/2016] [Indexed: 01/08/2023]
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Abstract
Catastrophic antiphospholipid syndrome is a rapidly progressive life-threatening disease that causes multiple organ thromboses and dysfunction in the presence of antiphospholipid antibodies. A high index of clinical suspicion and careful investigation are required to make an early diagnosis so that treatment with anticoagulation and corticosteroids can be initiated; plasma exchange and/or intravenous immunoglobulins can be added if the life-threatening condition persists. Despite aggressive treatment and intensive care unit management, patients with catastrophic antiphospholipid syndrome have a 48% mortality rate, primarily attributable to cardiopulmonary failure. This article reviews the current information on the etiopathogenesis, clinical manifestations, diagnosis, management, and prognosis of catastrophic antiphospholipid syndrome.
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Affiliation(s)
- Setu K Vora
- Pulmonary Physicians of Norwich, Norwich, Connecticut, USA
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Seckin NC, Inegöl I, Turhan NO, Bavbek N. Diagnosis of Antiphospholipid Syndrome During the Diagnostic Workup of Second-Trimester Fetal Bradycardia. Clin Appl Thromb Hemost 2016; 11:231-3. [PMID: 15821832 DOI: 10.1177/107602960501100215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Antiphospholipid syndrome (APS) is an autoimmune disorder associated with either arterial and/or venous thrombosis (1). Two cases of APS, which were diagnosed in the second trimester during the diagnostic workup of fetal bradycardia, are presented.
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Affiliation(s)
- Neslihan Carda Seckin
- Department of Obstetrics and Gynecology, Fatih University Faculty of Medicine, Ankara, Turkey.
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Konin C, Anzouan-Kacou JB, Essam N'loo A. Arterial thrombosis in patients with human immunodeficiency virus: two-case reports and review of the literature. Case Rep Vasc Med 2011; 2011:847241. [PMID: 22937467 PMCID: PMC3420687 DOI: 10.1155/2011/847241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 07/11/2011] [Indexed: 11/18/2022] Open
Abstract
Thrombosis during HIV infection was commonly vein thrombosis. Arterial thrombosis is also more and more described. We report two cases detected in the Abidjan Cardiology Institute. Case Reports. Case 1: an HIV infected female presented with sudden loss of consciousness and right hemiplegia. She had been taking HAART regimen for five years. Neck vessels ultrasonography revealed thrombosis on left ICA. Anticoagulant treatment leads to reduction of symptoms and left ICA partial recanalization. Case 2: male HIV infected taking HAART therapy was admitted for an acute pain of left lower limb; examination showed a decrease of heat, sensitivity, and mobility of this limb with popliteal and tibial pulses abolished. Arterial ultrasonography and CT angiography showed occlusion on the lower third of superficial femoral artery and homolateral popliteal artery suggesting a thrombosis of this artery. He underwent a femorotibial bypass surgery and anticoagulant treatment. The outcome was good with reappearance of local heat of the limb and tibial pulses. Probable etiology is early carotid atherosclerosis associated with protein S deficiency in the first case and antiphospholipid syndrome in the second case. Conclusion. Arterial thrombosis might occur in HIV infection. Several etiological factors could be involved in the pathogeny of these arterial thromboses.
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Affiliation(s)
- C. Konin
- Abidjan Cardiology Institute, BP 487, Abibjan 22, Cote D'Ivoire
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Arnson Y, Shoenfeld Y, Alon E, Amital H. The Antiphospholipid Syndrome as a Neurological Disease. Semin Arthritis Rheum 2010; 40:97-108. [DOI: 10.1016/j.semarthrit.2009.05.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Revised: 04/08/2009] [Accepted: 05/03/2009] [Indexed: 02/06/2023]
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Predictors of Pregnancy Outcome in Antiphospholipid Syndrome: A Review. Clin Rev Allergy Immunol 2009; 38:116-24. [DOI: 10.1007/s12016-009-8144-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Rueda JC, Duque MAQ, Mantilla RD, Iglesias-Gamarra A. Osteonecrosis and Antiphospholipid Syndrome. J Clin Rheumatol 2009; 15:130-2. [DOI: 10.1097/rhu.0b013e31819dbd20] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zifman E, Rotman-Pikielny P, Berlin T, Levy Y. Insertion of inferior vena cava filters in patients with the antiphospholipid syndrome. Semin Arthritis Rheum 2008; 38:472-7. [PMID: 18395774 DOI: 10.1016/j.semarthrit.2008.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Revised: 01/06/2008] [Accepted: 01/28/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND The antiphospholipid syndrome (APS) is a disease with a high prevalence of thromboembolic events, especially pulmonary emboli (PE). These events may recur despite anticoagulation therapy. In such cases, placement of an inferior vena cava (IVC) filter may be considered to prevent propagation of a distal thrombus toward the pulmonary vessels. It is unclear whether the placement of such a filter is beneficial in patients with APS. OBJECTIVE Retrospective evaluation of the value of IVC filter placement as prophylaxis against recurrent pulmonary emboli in patients with medically treated APS. METHODS We identified 10 patients suffering from APS who, despite anticoagulation treatment, had recurrent thromboembolic events. All of them underwent placement of an IVC filter. We examined their medical files for further recurrences. RESULTS Of the 10 patients in our study, only 1 had a documented PE following the intervention. The remaining patients had no evidence of PE after the filter insertion. Five of the 10 patients died, 2 of them suddenly. In those 2 patients, the cause of death is unknown, but PE cannot be excluded. CONCLUSION IVC filters seem to be protective against recurrent PE in APS patients but the true extent of their efficacy requires further study.
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Affiliation(s)
- Eyal Zifman
- Department of Medicine E, Meir Medical Center, Kfar-Saba, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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De Carolis S, Botta A, Garofalo S, Ferrazzani S, Martino C, Fatigante G, Caforio L, Caruso A. Uterine Artery Velocity Waveforms as Predictors of Pregnancy Outcome in Patients with Antiphospholipid Syndrome: A Review. Ann N Y Acad Sci 2007; 1108:530-9. [PMID: 17894018 DOI: 10.1196/annals.1422.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In pregnant women, antiphospholipid syndrome (APS) is associated with an increased risk for preeclampsia, fetal intrauterine growth restriction, and other complications related to uteroplacental insufficiency. In normal pregnancy, impedance to flow in the uterine arteries decreases with gestation, as the likely consequence of the physiologic change of spiral arteries into low-resistance vessels. The presence of antiphospholipid antibodies can impair this vascular adaptation, resulting in a reduced placental perfusion. Doppler investigation provides a noninvasive method for the study of uteroplacental blood flow. Several studies were performed to detect the predictive role of uterine artery Doppler velocimetry in relation to pregnancy outcome in APS patients. In some studies, a high resistance index in the uterine arteries strongly predicted the subsequent development of obstetric complications. In other studies, persistent bilateral uterine artery notches identified the risk of preeclampsia and fetal intrauterine growth restriction. To date, the uterine artery Doppler velocimetry resulted to be a useful tool for identifying APS pregnancies at risk for adverse pregnancy outcome. These findings might have important implications for the management of these patients.
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Affiliation(s)
- Sara De Carolis
- Department of Obstetrics and Gynecology, Catholic University, Rome, Italy.
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Carbillon L, Uzan M, Kettaneh A, Letellier E, Stirnemann J, Perrot N, Tigaizin A, Fain O. Prééclampsie et syndrome des antiphospholipides. Intérêt du Doppler utéroplacentaire. Rev Med Interne 2006; 27:111-6. [PMID: 16364508 DOI: 10.1016/j.revmed.2005.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2005] [Accepted: 10/16/2005] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Women with persistently high resistance in uterine arteries have an increased risk of the subsequent development of preeclampsia. Doppler investigation provides a non-invasive method for the study of the uteroplacental blood flow. In pregnant women the antiphospholipid syndrome is associated to an increased risk of preeclampsia and complications related to uteroplacental insufficiency, and the role of uterine artery Doppler is discussed. CURRENT KNOWLEDGE AND KEY POINTS In normal pregnancy, impedance to flow in the uterine arteries decreases with gestation, as the likely consequence of the physiologic change of spiral arteries into low-resistance vessels. In women with preeclampsia or related complications, the abnormal persistence of high resistance to flow in the uterine arteries correlates with maternal and neonatal outcome. In one study including patients with antiphospholipid syndrome, a high resistance index in the uterine arteries at 22-24 weeks gestation strongly predicted the subsequent development of preeclampsia. In another study including patients with lupus anticoagulant, persistent bilateral notches at 22-24 weeks gestation may identify preeclampsia and fetal growth restriction with a high sensitivity, specificity, positive and negative predictive value. The treatment may improve the uteroplacental blood flow and is a possible confounding factor which needs further evaluation. FUTURE PROSPECTS AND PROJECTS; In patients with antiphospholipid antibodies a higher impedance has been observed in the uterine artery, suggesting a possible vascular dysfunction precluding to impaired trophoblastic invasion and placental thrombosis, as probable mechanisms in the complications. If confirmed, these findings might have important implications for the management of these patients.
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Affiliation(s)
- L Carbillon
- Service de gynécologie-obstétrique, hôpital Jean-Verdier, Bondy, France.
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Abstract
OBJECTIVE Hydroxychloroquine (HCQ) is often needed to manage disease activity in systemic lupus erythematosus (SLE) during pregnancy. The purpose of this study was to examine lupus activity and pregnancy outcomes in women with SLE treated or not treated with HCQ during pregnancy. METHODS This was a prospective study of pregnancies in women with SLE who were evaluated between 1987 and 2002. The pregnancies were divided into 3 groups: no HCQ exposure during pregnancy (163 pregnancies), continuous use of HCQ during pregnancy (56 pregnancies), or cessation of HCQ treatment either in the 3 months prior to or during the first trimester of pregnancy (38 pregnancies). The pregnancy outcomes, fetal outcomes, and lupus activity during pregnancy were compared among these groups. RESULTS The rates of miscarriage, stillbirth, pregnancy loss, and congenital abnormality were not statistically different among the 3 groups. The degree of lupus activity during pregnancy, however, was significantly higher in women who stopped taking HCQ. These women had a higher degree of lupus activity, as measured by the physician's estimate of lupus activity and the SLE Disease Activity Index, as well as an increased rate of flare, during pregnancy. More serious lupus complications, such as proteinuria and thrombocytopenia, were not significantly higher in women who stopped taking HCQ. Women who continued taking HCQ were maintained on a lower average dose of prednisone during pregnancy. CONCLUSION We recommend the continuation of HCQ treatment during pregnancy. Our findings are consistent with prior reports of the absence of fetal toxicity. Similar to studies of nonpregnant women, the cessation of HCQ treatment during pregnancy increases the degree of lupus activity.
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Affiliation(s)
- Megan E B Clowse
- Duke University Medical Center, Durham, North Carolina 27710, USA.
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Abstract
Antiphospholipid syndrome is an autoimmune disorder characterized by the association between antiphospholipid antibodies and venous or arterial thrombosis or obstetric complications. In spite of the recent progresses, many aspects of this disease remain unclear. In this review, we briefly focus on the most important advances in the pathophysiology, diagnosis and treatment of this condition.
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Affiliation(s)
- Massimo Franchini
- Servizio di Immunoematologia e Trasfusione, Azienda Ospedaliera di Verona, Piazzale Ludovico Scuro, 37134 Verona, Italy.
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Male C, Foulon D, Hoogendoorn H, Vegh P, Silverman E, David M, Mitchell L. Predictive value of persistent versus transient antiphospholipid antibody subtypes for the risk of thrombotic events in pediatric patients with systemic lupus erythematosus. Blood 2005; 106:4152-8. [PMID: 16144797 DOI: 10.1182/blood-2005-05-2048] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Study objectives were to determine, in children with systemic lupus erythematosus (SLE), (1) the association of antiphosholipid antibody (APLA) subtypes with thrombotic events (TEs) and (2) the predictive value of persistent versus transient antibodies for TEs. This is a cohort study of 58 SLE children in whom lupus anticoagulants (LAs), anticardiolipin antibodies (ACLAs), anti–β2-glycoprotein-I (anti–β2-GPI), and antiprothrombin (anti-PT) were assessed on at least 2 occasions (more than 3 months apart). Antibodies were classified as persistent (positive on at least 2 occasions) or transient (positive once). Outcomes were symptomatic TEs confirmed by objective radiographic tests identified retrospectively and prospectively. Seven of the 58 patients (12%) had 10 TEs; 5 patients had TEs during prospective follow-up. Persistent LAs showed the strongest association with TEs (P < .001). Persistent ACLAs (P = .003) and anti–β2-GPI (P = .002) were significantly associated with TEs; anti-PT (P = .063) showed a trend. Persistent or transient LAs and anti–β2-GPI showed similar strength of association, while ACLAs and anti-PT were no longer associated with TEs. Positivity for multiple APLA subtypes showed stronger associations with TEs than for individual APLA subtypes because of improved specificity. Lupus anticoagulant is the strongest predictor of the risk of TEs; other APLA subtypes provide no additional diagnostic value. Anticardiolipin antibodies and anti-PT require serial testing because only persistent antibodies are associated with TEs.
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Affiliation(s)
- Christoph Male
- Children's Hospital, Medical University of Vienna, Austria
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Richani K, Romero R, Soto E, Espinoza J, Nien JK, Chaiworapongsa T, Refuerzo J, Blackwell S, Edwin SS, Santolaya-Forgas J, Mazor M. Unexplained intrauterine fetal death is accompanied by activation of complement. J Perinat Med 2005; 33:296-305. [PMID: 16207114 DOI: 10.1515/jpm.2005.052] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Activation of the complement system has recently been implicated in the mechanisms of fetal loss in the antiphospholipid syndrome. It is, however, possible that complement activation is also involved in other causes of fetal death in the second and third trimesters of pregnancy. We therefore conducted a study to determine whether fetal death is associated with changes in the maternal plasma concentrations of complement split products or anaphylatoxins (C3a, C4a and C5a). STUDY DESIGN A cross-sectional study was designed to include normal pregnant women (n=60) and patients with fetal death (n=60). Patients with fetal death were classified according to the cause of fetal demise into: a) unexplained (n=44); b) associated with preeclampsia (n=8); and c) associated with chromosomal abnormalities or major congenital fetal anomalies (n=8). The plasma concentrations of C3a, C4a and C5a were measured using sensitive and specific ELISAs. Non-parametric statistics were used for analysis. A P value of <0.05 was considered significant. RESULTS 1) The median plasma concentration of C5a was higher in patients with fetal death than in normal pregnant women [median 16 ng/mL (range 4.5-402.5) vs. median 11.6 ng/mL (range 1.2-87.1), respectively; P<0.001]; 2) patients with an unexplained fetal death and those associated with preeclampsia had a higher median plasma C5a concentration than normal pregnant women (P=0.002 and P<0.001, respectively); 3) no differences were observed in the maternal plasma concentrations of C3a and C4a among the study groups. CONCLUSIONS Unexplained fetal death is associated with evidence of complement activation.
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Affiliation(s)
- Karina Richani
- Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, MD, United States
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Carbillon L, Sauvet ML, Fain O, Aurousseau MH. Treated pregnant patients with antiphospholipid syndrome are particularly susceptible to pre-eclampsia and fetal growth retardation. J Reprod Immunol 2005; 65:89-90. [PMID: 15694970 DOI: 10.1016/j.jri.2004.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2004] [Revised: 09/12/2004] [Accepted: 09/29/2004] [Indexed: 11/29/2022]
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Abstract
The description of antiphospholipid syndrome (APS) is vascular thrombosis and/or pregnancy morbidity occurring in persons with antiphospholipid antibodies (aPL). However, because of an unclear etiopathogenesis and the heterogeneous nature of aPL and of aPL-related clinical manifestations, a single, unambiguous definition of APS does not exist. In this paper, we describe a structured approach to APS, discuss the controversies, and offer descriptions of APS that include: an autoimmune systemic disease with a spectrum of (mostly thrombotic) clinical manifestations, an overdiagnosed disease when aPL is present but has no proven direct causative role in the clinical manifestations, and a disease of controversies that requires clarification of etiology and mechanisms and risk-stratified controlled clinical studies.
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Affiliation(s)
- Doruk Erkan
- Department of Rheumatolopgy, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA.
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Oztürk MA, Haznedaroğlu IC, Turgut M, Göker H. Current debates in antiphospholipid syndrome: the acquired antibody-mediated thrombophilia. Clin Appl Thromb Hemost 2004; 10:89-126. [PMID: 15094931 DOI: 10.1177/107602960401000201] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Antiphospholipid (APL) syndrome is the most common form of acquired thrombophilia. It can cause significant morbidity and even mortality. The term "APL antibodies" represents a heterogeneous group of antibodies associated with this disorder. Currently no single assay can identify every APL antibody. Clinically relevant APL antibodies are mainly anticardiolipin antibodies (ACA) detected by solid phase enzyme-linked immunosorbent assay (ELISA) and lupus anticoagulants (LA) demonstrated by in vitro coagulation assay. However, there are some other antibodies associated with the APL syndrome (i.e., subgroup APL antibodies). ACAs, LAs, and subgroup APL antibodies represent intersecting, but non-identical, subsets of autoantibodies. Thus, those autoantibodies may coexist or may occur independently. Any organ system and any size of vessel can be affected during the clinical course of the disease. Therefore, the APL syndrome can manifest itself in a wide variety of clinical thrombotic features. Fetal loss and pregnancy morbidity represent a specific challenge. Despite tremendous advances in the understanding of the pathogenesis of APL syndrome during the past decade, the mainstay of management is still anticoagulation. However, there is no general agreement regarding the duration and intensity of anti-coagulant therapy. In this review, we focused on the current dilemmas and their present clarifications in the wide clinicopathologic spectrum of APL syndrome and APL antibody-related distinct pathologic conditions.
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Affiliation(s)
- M Akif Oztürk
- Gazi University School of Medicine Department of Rheumatology, Ankara, Turkey.
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Wong R, Wilson R, Pollock W, Steele R, Gillis D. Anti-cardiolipin antibody testing and reporting practices among laboratories participating in a large external Quality Assurance Program. Pathology 2004; 36:174-81. [PMID: 15203755 DOI: 10.1080/00313020410001672046] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIMS To investigate differences in anti-cardiolipin antibody (aCL) testing and reporting practices among diagnostic laboratories participating in the RCPA Quality Assurance Program (QAP) Immunology Program. METHODS A survey was sent to all 58 laboratories enrolled for aCL testing in the RCPA QAP Program requesting the following information: (1). manufacturer/type of assay; (2). isotype tested; (3). use of calibrators and controls; (4). whether calibrators, control and patient specimens were performed in singles or duplicates; (5). whether results were reported semi-quantitatively and/or numerically; (6). values used to define negative/positive and semi-quantitative cut-offs and how they were determined; and (7). whether interpretative comments were provided and their content. RESULTS Thirty-two surveys (55%) were received. Significant differences were present particularly in the following areas: (1). whether IgM isotype aCL testing was performed routinely or only on specific request; (2). whether controls/calibrators/specimens were tested in singles or duplicates; (3). whether results were reported numerically and/or semi-quantitatively; (4). the values used to define negative/positive and semi-quantitative range cut-offs; and (5). whether interpretative comments were provided and their content. CONCLUSIONS These differences in testing and reporting practices are likely to contribute to the variation in aCL results reported by different laboratories, particularly among those using the same assay.
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Affiliation(s)
- Richard Wong
- Division of Immunology, Queensland Health Pathology Services, Princess Alexandra and Royal Brisbane Hospitals, Queensland, Australia.
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Orts J, Colomina J, Zuniga A, Guerrero A. Cytomegalovirus infection and antiphospholipid syndrome in humans. ACTA ACUST UNITED AC 2003; 48:3296-7. [PMID: 14613298 DOI: 10.1002/art.11319] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
Antiphospholipid antibodies are autoantibodies directed against anionic phospholipids or protein-phospholipid complexes measured in solid-phase immunoassays such as anticardiolipin (aCL) antibody or detected in phospholipid-dependent clotting tests as lupus anticoagulant (LA). The term "antiphospholipid syndrome (APS)" was first coined to denote the clinical association between antiphospholipid antibodies and a syndrome of episodes of thrombosis in arteries and/or veins, pregnancy loss, and thrombocytopenia. The diagnosis of APS is based on the finding of "moderate-to-high" aCL antibody titer and/or an LA test with any one of the characteristic clinical features presented. Recently, the diagnostic criteria of APS was revised and several newer assays that use phosphatidylserine, a mixture of negatively charged phospholipids or beta2-glycoprotein 1 (beta2-GP1) have been proposed for more specific measurements of antibodies present in APS. In this section, recent progress in the laboratory diagnosis of antiphopholipid syndrome will be discussed.
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Affiliation(s)
- Hyun-Sook Chi
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
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Recurrent Pregnancy Loss With Antiphospholipid Antibody. Obstet Gynecol 2002. [DOI: 10.1097/00006250-200207000-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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