Lupus anticoagulantlupus anticoagulant, lupus anticoagulant disorder
Lupus anticoagulant also known as lupus antibody, LA, LAC, or lupus inhibitors is an immunoglobulin that binds to phospholipids and proteins associated with the cell membrane Lupus anticoagulant is a misnomer, as it is actually a prothrombotic agent Lupus anticoagulant antibodies in living systems cause an increase in inappropriate blood clotting The name derives from their properties in vitro, as these antibodies increase laboratory coagulation tests such as the aPTT Investigators speculate that the antibodies interfere with phospholipids used to induce in vitro coagulation In vivo, the antibodies are thought to interact with platelet membrane phospholipids, increasing adhesion and aggregation of platelets, which accounts for the in vivo prothrombotic characteristics
The condition was first described by hematologist C Lockard Conley
- 1 Terminology
- 2 Workup
- 3 Treatment
- 4 References
Both words in the term "lupus anticoagulant" can be misleading:
- Most patients with a lupus anticoagulant do not actually have lupus erythematosus, and only a small proportion will proceed to develop this disease which causes joint pains, skin problems and renal failure, amongst other complications Patients with lupus erythematosus are more likely to develop a lupus anticoagulant than the general population
- The term "anticoagulant" accurately describes its function in vitro However in vivo, it functions as a procoagulant
The presence of prolonged clotting times on a routine plasma test often triggers functional testing of the blood clotting function, as well as serological testing to identify common autoantibodies such as antiphospholipid antibodies These antibodies tend to delay in-vitro coagulation in phospholipid-dependent laboratory tests such as the partial thromboplastin time
The initial workup of a prolonged PTT is a mixing test whereby the patient's plasma is mixed with normal pooled plasma and the clotting is re-assessed If a clotting inhibitor such as a lupus anticoagulant is present, the inhibitor will interact with the normal pooled plasma and the clotting time will remain abnormal However, if the clotting time of the mixed plasma corrects towards normal, the presence of an inhibitor such as the lupus anticoagulant is excluded, and instead a deficient quantity of clotting factor that is replenished by the normal plasma is likely
If the mixing test indicates an inhibitor, diagnosis of a lupus anticoagulant is then confirmed with prolonged phospholipid-sensitive functional clotting testing, such as the dilute Russell's viper venom time, or the Kaolin clotting time As a further confirmation, a second test with the addition of excess phospholipid will correct the prolongation conceptually known as "phospholipid neutralization", confirming the diagnosis of a lupus anticoagulant
Treatment for a lupus anticoagulant is usually undertaken in the context of documented thrombosis, such as extremity phlebitis or dural sinus vein thrombosis Patients with a well-documented ie, present at least twice lupus anticoagulant and a history of thrombosis should be considered candidates for indefinite treatment with anticoagulants Patients with no history of thrombosis and a lupus anticoagulant should probably be observed Current evidence suggests that the risk of recurrent thrombosis in patients with an antiphospholipid antibody is enhanced whether that antibody is measured on serological testing or functional testing The Sapporo criteria specify that both serological and functional tests must be positive to diagnose the antiphospholipid antibody syndrome
Miscarriages may be more prevalent in patients with a lupus anticoagulant Some of these miscarriages may potentially be prevented with the administration of aspirin and unfractionated heparin The Cochrane Database of Systematic Reviews provide a deeper understanding on the subject
Thrombosis is treated with anticoagulants LMWHs and warfarin
- ^ Antonia Joussen; TW Gardner; B Kirchhof 23 October 2007 Retinal Vascular Disease Springer pp 430– ISBN 978-3-540-29541-9 Retrieved 29 June 2010
- ^ Conley, C Lockard 1952 "A hemorrhagic disorder caused by circulating anticoagulant in patients with disseminated lupus erythematosus" Journal of Clinical Investigation 31: 621–622 doi:101172/JCI102648 PMC 436459
- ^ "Lock Conley looks back and blushes" Hopkins Medicine Spring–Summer 2006 Retrieved 5 December 2013
- ^ "wustledu" Retrieved 2009-02-17
- ^ Viard JP, Amoura Z, Bach JF 1991 "" Comptes Rendus de l'Académie des Sciences, Série III in French 313 13: 607–12 PMID 1782567
- ^ Empson, M; Lassere, M; Craig, J; Scott, J Apr 18, 2005 "Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant" PDF The Cochrane Database of Systematic Reviews 2: CD002859 doi:101002/14651858CD002859pub2 PMID 15846641
- ^ Dolitzky M, Inbal A, Segal Y, Weiss A, Brenner B, Carp H 2006 "A randomized study of thromboprophylaxis in women with unexplained consecutive recurrent miscarriages" Fertil Steril 86 2: 362–6 doi:101016/jfertnstert200512068 PMID 16769056
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