CLINICAL AND LABORATORY FEATURES ASSOCIATED WITH LUPUS ANTICOAGULANT

 

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Recent evidence suggests a relationship between the presence of lupus anticoagulant and elevated titres of antibody to cardiolipin. Also an association with thrombotic tendency and with a high incidence of first trimester spontaneous abortion or second and third trimester fetal death has been noted. In order to investigate the relationship between anticardiolipin (aCL) antibodies and coagulation test abnormalities we have studied 12 subjects with systemic lupus erythematosus (SLE),10 with history of venous thrombosis, 30 with unexplained prolongation of clotting times and 34 with a poor obstetric history. Coagulation tests applied were: KCCT using two ’incomplete’ thromboplastin preparations and corrections with 20%/50% normal plasma; one-stage prothrombin time (OSP); dilute Russell’s viper venom time (DRVVT, including the platelet neutralisation procedure) and the heat stability test. IgG and IgM aCL antibody were assayed by enzyme-linked immunosorbent assay as described elsewhere. Abnormalities in more than one coagulation test were detected in 4 subjects with SLE (33%), 4 with thrombosis (40%), 6 with poor obstetric history (18%) and 10 with unexplained prolonged KCCT (33%). The DRVVT was most sensitive to the presence of lupus anticoagulant. Detectable aCL antibody was present in 12 subjects (IgG in 6, IgM in 4, both in 3), including some from each group. 2 had IgG aCL antibody and normal coagulation tests (1 SLE, 1 poor obstetric history). No coagulation or immunological abnormality was detected in 30 healthy non-pregnant and 13 healthy pregnant controls. Our data indicate the requirement for a comprehensive methodological approach for the detection of aCL antibodies/lupus anticoagulant and the clinical importance of such an approach.