Lupus anticoagulant

Protein C, protein S, antithrombin III, activated protein C resistance, lipoprotein(a) anticardiolipin antibodies, lupus anticoagulant, prothrombin gene mutation 20210a... 

Activated partial thromboplastin time aPTT is performed by adding calcium phospholipids and kaolin to citrated blood and measures the time required for a fibrin clot to form. In this manner, aPTT measures the activity of intrinsic and common pathways. Prolongation of aPTT may be due to a deficiency or inhibitor for factors II, V, VIII, IX, X, XI, and XII. It also may be due to heparin, direct thrombin inhibitors, vitamin K deficiency, liver disease, or lupus anticoagulant. 

Antiphospholipid antibodies include lupus anticoagulants (LAs) and anticardi-olipin (aCL) antibodies. Lupus anticoagulants are immunoglobulins that are characterized by their ability to inhibit phospholipid-dependent coagulation assays. In contrast, aCL antibodies are measured in an enzyme-linked immunosorbent assay... 

Whereas (32 glycoprotein 1 ((J2-GPI) is the target of anticardiolipin antibodies, prothrombin is the antigen for most lupus anticoagulants. Both these antibodies are risk factors for both venous and arterial thrombosis. In addition, complications such as thrombocytopenia and recurrent miscarriages are manifestations of the so-called antiphospholipid syndrome (97). 

Prescribing perspective is to recognize that the previously acceptable counts, on treatment, between (500-650) X (f are hazardous since microvas-cular occlusion, including stroke, remain risks. The concurrent role of aspirin continues to be defined. Thus, while this has a sound theoretical benefit and is recommended to decrease platelet-endothelial cell interaction, occasional gastrointestinal tract bleeding may be found. Furthermore, associated hypercoagulability may be found and determinations of proteins C and S, mutations of factor V and II or elevated homocysteine, as well as the presence of anti-cardiolipin syndrome or lupus anticoagulant should not be overlooked. 

Schallmoser, K., Rosin, C., Vormittag, R., et al. (2006), Specificities of platelet autoantibodies and platelet activation in lupus anticoagulant patients A relation to their history of thromboembolic disease, Lupus, 15(8), 507-514. 

Combes V, Simon AC, Grau GE, Arnoux D, Camoin L, Sabatier F, Mutin M, Sanmarco M, Sampol J, Dignat-George F. In vitro generation of endothelial microparticles and possible prothrombotic activity in patients with lupus anticoagulant. J Clin Invest 1999 104 93-102. 

The neurologic involvement in Crohn s disease can be attributed to several mechanisms including autoimmunity. For the predominant arterial cerebrovascular involvement, the state of hyper coagulation secondary to thrombocytosis and increase in factor V, Vm and fibrinogen are probable mechanisms. However, since anti-phospholipid antibodies and lupus anticoagulant are confirmed in many cases, autoimmune mechanisms are also involved (Santos et al., 2001). 

Lupus anticoagulant Myeloproliferative disease (31) Paroxysmal nocturnal haemoglobinuria Polycythaemia vera Protein C deficiency (68)... 

The combination of lamotrigine with valproate has been reported to have caused the production of lupus anticoagulant (100). 

Echaniz-Laguna A, Thiriaux A, Ruolt-Olivesi I, Marescaux C, Hirsch E. Lupus anticoagulant induced by the combination of valproate and lamotrigine. Epilepsia 1999 40(ll) 1661-3. 

The most common feature is arthralgia, in about 77% of cases, with pleural or lung involvement in about 75%. Other common features include myalgia, fever, hepatomegaly, pericarditis, arthritis, and splenomegaly. Skin rashes, adenopathy, and Raynaud s phenomenon occur in 5-10% of cases, and neuropsychiatric and renal involvement are rare. Thrombotic problems can occur because of the properties of anti-DNA and antiphospholipid antibodies (discussed in the next case report). The so-called lupus anticoagulant can be detected in people taking procainamide, even without clinical evidence of lupus... 

Heyman MR, Flores RH, Edehnan BB, Carliner NH. Procainamide-induced lupus anticoagulant. South Med J 1988 81(7) 934-6. 

A lupus-like syndrome has occasionally been reported in patients taking quinidine (60,61,64). It usually presents with polyarthralgia, a raised erythrocyte sedimentation rate, and a raised antinuclear antibody titer. It can occasionally be associated with antihistone antibodies and a circulating coagulant. In two cases (65) the syndrome was associated with quinidine and not with procainamide. Lupus anticoagulant has been reported with the use of quinine and quinidine, and an associated antiphospholipid syndrome has been described (66). 

Bird MR, O Neill AI, Buchanan RR, Ibrahim KM, Des Parkin J. Lupus anticoagulant in the elderly may be associated with both quinine and quinidine usage. Pathology 1995 27(2) 136-9. 

Lupus anticoagulant has been reported with the use of quinine and quinidine, and an associated antiphospholipid syndrome has been described (22). 

Tests for hypercoagulable states (protein C deficiency, antiphospholipid antibody) should be done only when the cause of the stroke cannot be determined based on the presence of well-known risk factors for stroke. Protein C, protein S, and antithrombin III are best measured in the "steady state," not in the acute stage. Antiphospholipid antibodies as measured by anticardiolipin antibodies, /S2-glycoprotein I, and lupus anticoagulant screen are of higher yield than protein C, protein S, and antithrombin III but should be reserved for patients who are young (<50 years), have had multiple venous/arterial thrombotic events, or have livedo reticularis (a skin rash). 

Positive finding of antiphospholipid antibodies based on (1) an abnormal serum level of IgG or IgM anticardiolipin antibodies, (2) a positive test result for lupus anticoagulant using a standard method, or (3) a false-positive serologic test for syphilis known to be positive for at least 6 months and confirmed by Treponema pallidum immobilization or fluorescent treponemal antibody absorption test. 

PT) 1, ll,V, VII, X Vitamin K deficiency Inherited factor deficiencies Warfarin Liver disease Lupus anticoagulant Afibrinogenemia trau ma, etc Easy bruising... 

Antiphospholipid antibodies (aPL). Autoantibodies directed against neutral or negatively charged phospholipids including anticardiolipin antibodies (aCl) and lupus anticoagulant. They are diagnostic markers of the antiphospholipid syndrome, although they are also found in patients with other (autoimmune) diseases and infections. 

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