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1.
Am J Clin Pathol ; 152(5): 638-646, 2019 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-31305881

RESUMO

OBJECTIVES: Anti-ß2 glycoprotein I domain I (anti-domain I) and anti-phosphatidylserine/prothrombin (aPS/PT) antibodies are present in patients with antiphospholipid syndrome (APS); however, their use in evaluation remains unclear. METHODS: Diagnostic attributes of lupus anticoagulant (LAC), anti-domain I IgG, anti-cardiolipin, anti-ß2 glycoprotein I (anti-ß2GPI), and aPS/PT IgG and IgM antibodies were assessed in 216 patients evaluated for APS. RESULTS: LAC had the best odds ratio (OR, 14.2) while that for anti-domain 1 IgG was comparable to anti-ß2GPI IgG (OR, 8.3 vs 9.4) but higher than all others. Significant correlations were observed for thrombosis (P = .03) and pregnancy-related morbidity (P = .001) with anti-domain IgG and for any thrombosis with aPS/PT IgG (P = .006). Use of noncriteria antiphospholipid with or without criteria markers did not significantly increase the probability to diagnose APS. CONCLUSIONS: Noncriteria tests can contribute to diagnosis and stratification of APS but do not improve diagnostic yield. Optimal strategies for implementation require prospective investigation.


Assuntos
Anticorpos Antifosfolipídeos/sangue , Síndrome Antifosfolipídica/diagnóstico , Autoanticorpos/sangue , Adulto , Síndrome Antifosfolipídica/classificação , Síndrome Antifosfolipídica/imunologia , Cardiolipinas/imunologia , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Inibidor de Coagulação do Lúpus/sangue , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fosfatidilserinas/imunologia , Gravidez , Complicações na Gravidez/imunologia , Protrombina/imunologia , Estudos Retrospectivos , beta 2-Glicoproteína I/imunologia
2.
Autoimmun Rev ; 17(12): 1210-1218, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30316989

RESUMO

As the clinical symptoms of the antiphospholipid syndrome (APS) frequently occur irrespective of the syndrome, diagnosis predominantly depends on the laboratory assays measuring the level or function of antiphospholipid antibodies (aPLs). ß2-glycoprotein I (ß2GPI) is increasingly accepted as the most important target of aPLs. Anti-ß2GPI antibodies constitute a heterogeneous population, but current in vivo and in vitro evidence show that especially the first domain (DI) of ß2GPI contains an important pathogenic epitope. This epitope containing Glycine40-Arginine43 (G40-R43) has proven to be cryptic and only exposed when ß2GPI is in its open conformation. A previous study demonstrated a highly variable exposure of the cryptic epitope in commercial anti-ß2GPI assays, with implications on correct patient classification. Unexpectedly, recent unpublished data revealed impaired exposure of the pathogenic epitope in the commercially available anti-DI chemiluminescence immunoassay (CIA) assay detecting specific antibodies directed to DI. In this review we summarize the laboratory and clinical performance characteristics of the different anti-DI assays in published data and conclude with inconsistent results for both the correlation of anti-DI antibodies with clinical symptoms and the added value of anti-DI antibodies in the classification criteria of APS. Additionally, we hypothesize on possible explanations for the observed discrepancies. Finally, we highly advise manufacturers to use normal pooled plasma spiked with the monoclonal anti-DI antibodies to verify correct exposure of the cryptic epitope.


Assuntos
Anticorpos Antifosfolipídeos/sangue , Síndrome Antifosfolipídica/classificação , Síndrome Antifosfolipídica/diagnóstico , Epitopos/imunologia , beta 2-Glicoproteína I/imunologia , Anticorpos Antifosfolipídeos/imunologia , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/imunologia , Humanos , Imunoensaio
3.
Autoimmun Rev ; 17(9): 866-872, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30005859

RESUMO

OBJECTIVES: To assess the limitations of the SLICC (Systemic Lupus International Collaborating Clinics) classification criteria for systemic lupus erythematosus (SLE), in patients with primary antiphospholipid syndrome (PAPS). METHODS: Retrospective study of a cohort of APS patients (Sydney criteria). We successively excluded patients with (1) at least one "SLE-specific" manifestation (biopsy-proven SLE nephropathy, arthritis, cutaneous, or neurologic SLE manifestations, pericarditis, autoimmune haemolytic anaemia, oral and nasal ulcers, non-scarring alopecia, anti-dsDNA, and anti-Sm antibodies), (2) any other autoimmune connective tissue disease, and/or (3) antinuclear antibodies >1/320. Careful file review confirmed PAPS among the remaining patients. We then assessed the number of SLICC criteria each patient met. RESULTS: Among these 214 APS patients, we excluded 85 with at least one SLE-specific manifestation, 8 with another connective tissue disease, and 21 with antinuclear antibodies >1/320, leaving 100 patients with primary APS. Among them, 28% met at least 4 SLICC classification criteria including one clinical and one immunological criterion (antiphospholipid antibodies, aPL, by definition) and could thus theoretically be classified with SLE. Fourteen had an arterial phenotype (50%), 9 a history of catastrophic APS (32%), and 18 a triple-positive profile for aPL (64%). None had developed SLE during a median follow-up of 12 [6.5-17] years. CONCLUSION: Because 28% of our patients with longstanding and strictly defined PAPS could be mistakenly classified as SLE, they were at risk of deleterious therapeutic management. We therefore suggest that any future classification for SLE should specifically require at least one SLE-specific criterion for patients with aPL.


Assuntos
Síndrome Antifosfolipídica/classificação , Lúpus Eritematoso Sistêmico/diagnóstico , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Retrospectivos
4.
Rheumatology (Oxford) ; 57(8): 1350-1357, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29672737

RESUMO

Objectives: aPL are frequently present in SLE. In a well characterized SLE cohort we aimed at investigating the prevalence of aPL and assessing their analytical performance and clinical association by testing criteria specificities including LA, aCL IgG and IgM, anti-ß2-glycoprotein 1 (antiß2GP1) IgG and IgM, as well as the non-criteria aPS-PT IgG and IgM and anti-ß2GP1 domain 1 (aD1) IgG. Methods: We included 178 patients satisfying the ACR SLE classification criteria, from whom 283 samples and thrombotic events were collected longitudinally. Each sample was tested for criteria and non-criteria aPL using validated techniques in a single centre. Results: All assays provided highly reproducible results. Of the samples, 42.5% were positive for at least one criteria assay, 20.5% showed double positivity and 12.6% triple positivity. All criteria and non-criteria specificities persisted over time. Most antibody titres were only moderately correlated; however, strong correlation was observed on one hand between aD1 IgG, antiß2GP1 IgG and aCL IgG, and on the other between aPS-PT IgG and LA. aD1 IgG titres were extremely elevated in triple-positive samples. aPS-PT IgG by itself, and jointly with LA, was associated with thrombosis, an association mostly driven by venous thrombotic events. Conclusions: In this SLE cohort, the non-criteria aPL aD1 IgG and aPS-PT IgG performed differently. aD1 IgG was highly enriched in triple-positive samples, and aPS-PT IgG, jointly with LA, was associated with thrombotic events.


Assuntos
Anticorpos Antifosfolipídeos/imunologia , Síndrome Antifosfolipídica/etnologia , Lúpus Eritematoso Sistêmico/epidemiologia , Trombose/epidemiologia , Adolescente , Adulto , Idoso , Síndrome Antifosfolipídica/classificação , Síndrome Antifosfolipídica/imunologia , Criança , Feminino , Seguimentos , Humanos , Lúpus Eritematoso Sistêmico/classificação , Lúpus Eritematoso Sistêmico/imunologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Suíça/epidemiologia , Trombose/imunologia , Fatores de Tempo , Adulto Jovem
5.
J Perinat Med ; 46(4): 387-400, 2018 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-28829758

RESUMO

BACKGROUND: Catastrophic antiphospholipid syndrome (CAPS) is an uncommon, often fatal, variant of the antiphospholipid syndrome (APS) that results in a widespread coagulopathy and high titres of antiphospholipid antibodies (aPL) and affects predominantly small vessels supplying organs with the development of multiorgan failure. It remains unclear why some patients develop the typical clinical picture of APS (thrombosis of large vessels), whereas others show the development of progressive microthrombosis, which the authors called "thrombotic storm" and multiple organ failure, that is, CAPS. MATERIALS AND METHODS: Since 2001-2016, we discovered 17 patients with CAPS development. CONCLUSION: CAPS is life-threatening condition, but optimal treatment for CAPS is not developed yet and the mortality rate is as high as 30%-40%.


Assuntos
Síndrome Antifosfolipídica/complicações , Complicações na Gravidez/etiologia , Síndrome Antifosfolipídica/classificação , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/terapia , Feminino , Humanos , Gravidez , Complicações na Gravidez/prevenção & controle , Trombofilia/complicações
6.
Immunol Res ; 65(1): 230-241, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27423434

RESUMO

Headaches have been extensively reported in Antiphospholipid syndrome (APS)/Antiphospholipid antibodies (aPL)-positive patients. The aim of this study was to highlight the prevalence of headaches among APS/aPL-positive patients and discuss its association with laboratory, clinical and imaging findings. We searched the literature through Google Scholar and PubMed for publications on the epidemiology, pathogenesis, laboratory, imaging and clinical findings, and management of headaches in APS/aPL-positive patients. The following keywords were used: Antiphospholipid, Hughes syndrome, anticardiolipin, lupus anticoagulant, anti-ß2 glycoprotein I, headache, migraine, tension, and cluster. All reports published between 1969 and 2015 were included. Migraine is the most commonly reported type of headache in APS/aPL-positive patients. Thrombotic and platelet dysfunction hypotheses have been studied to uncover the pathogenic role of aPL in the development of headaches. Several studies are reporting higher levels of aPL in primary and secondary APS migraineurs, but only few reached statistical significance. Migraine patients without clinical signs/symptoms of cerebral infarction rarely show positive imaging findings. Digital subtraction angiography shows promise in demonstrating small vascular lesions otherwise not detected on computed tomography, magnetic resonance imaging, or cerebral angiograms. Although it may be solitary and harmless in many cases, the deleterious effect of migraine on the quality of life of APS patients prompts rapid diagnosis and proper management. An anticoagulation trial is advisable in APS patients with migraine as many cases of severe, refractory migraine resolved with anticoagulation therapy. The profile of migraine headaches discussed in this study permits its candidacy for inclusion in future APS classification criteria.


Assuntos
Síndrome Antifosfolipídica/classificação , Transtornos de Enxaqueca , Anticorpos Antifosfolipídeos , Síndrome Antifosfolipídica/diagnóstico por imagem , Síndrome Antifosfolipídica/epidemiologia , Humanos , Transtornos de Enxaqueca/diagnóstico por imagem , Transtornos de Enxaqueca/epidemiologia
8.
Ugeskr Laeger ; 178(3): V09150730, 2016 Jan 18.
Artigo em Dinamarquês | MEDLINE | ID: mdl-26815583

RESUMO

Antiphospholipid syndrome (APS) is the association of antiphospholipid antibodies with thromboses and/or obstetric morbidity. Obstetric morbidity includes recurrent first trimester loss, stillbirth, intrauterine death, preeclam-psia, premature birth and fetal growth restriction. Although current treatment regimens including aspirin and low-molecular weight heparin have improved pregnancy outcomes, 30% of affected women have pregnancy complica-tions. Women with APS are therefore high-risk pregnancies who should be monitored in specialist centres according to international standards.


Assuntos
Síndrome Antifosfolipídica/complicações , Complicações na Gravidez/etiologia , Anticoagulantes/uso terapêutico , Antimaláricos/uso terapêutico , Síndrome Antifosfolipídica/classificação , Síndrome Antifosfolipídica/tratamento farmacológico , Aspirina/uso terapêutico , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Gravidez , Gravidez de Alto Risco
9.
Rinsho Byori ; 63(10): 1220-7, 2015 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-26897860

RESUMO

Antiphospholipid syndrome (APS), an acquired thrombotic condition, is a complex clinical state characterized by the presence of circulating antiphospholipid antibodies in patients with thrombosis or pregnancy morbidity. Revised APS classification criteria are used for diagnosis, which include at least one clinical criterion (thrombosis or pregnancy loss) and at least one of the laboratory criteria [anticardiolipin antibodies, anti-ß2GPI antibodies, lupus anticoagulant (LA)]. LA is also an independent risk factor for developing thrombosis, though some LA-positive cases have been reported to have a bleeding symptom. Lupus anticoagulant-hypoprothrombinemia syndrome (LAHPS) is a rare disorder characterized by a bleeding tendency due to low prothrombin activity in patients with LA, and has recently been reported not only in children but also in adults We have encountered LA cases with bleeding and low coagulation factor activities except for prothrombin. Based on our findings, we propose that LA-positive cases with a bleeding symptom and characterized by low coagulation factor activity including prothrombin be termed lupus anticoagulant-associated coagulopathy (LAAC). Furthermore, coagulation factor autoantibodies are often detected in LAAC patients; thus, correct measurement of LA is important to distinguish LAAC patients from those possessing an inhibitor to coagulation factors such as acquired hemophilia A as well as to select the optimal therapeutic strategy.


Assuntos
Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/imunologia , Inibidor de Coagulação do Lúpus/sangue , Animais , Anticorpos Antifosfolipídeos/sangue , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/classificação , Autoanticorpos/sangue , Biomarcadores/sangue , Técnicas de Laboratório Clínico/métodos , Diagnóstico Diferencial , Humanos , Hipoprotrombinemias/diagnóstico , Protrombina/imunologia , Fatores de Risco , Síndrome , Trombose/diagnóstico , Trombose/etiologia
10.
J Gynecol Obstet Biol Reprod (Paris) ; 44(5): 463-70, 2015 May.
Artigo em Francês | MEDLINE | ID: mdl-25042624

RESUMO

OBJECTIVE: The objective of our study was to compare treatment-based obstetrical outcomes in women with either thrombotic or obstetrical antiphospholipid syndrome (APS). MATERIALS AND METHODS: This was a historical cohort study conducted between 1998 and 2009 in 23 patients who had a total of 83 pregnancies. The syndrome was diagnosed using the 2006 Sapporo criteria. RESULTS: Thirty-one of these 83 pregnancies were valid before the diagnosis was made. A live infant was born in 22% of them, the infant being small for gestational age in 26% of cases. The fetus died in utero in a further 26% of cases. Pregnancies were subdivided into 2 groups depending on whether the initial event leading to APS diagnosis was obstetrical or thrombotic. Treatment (aspirin and low molecular weight heparin) was based on this classification: the latter was given in a curative dose for thrombotic events, in a preventive dose for obstetrical events. No fetal loss was observed when treatment was administered according to the protocol. Nevertheless, 20% of the pregnancies with obstetrical APS were complicated by smallness for gestational age and only 38% of the infants were live births. More than 87% of the thrombotic forms treated were free of complications and led to birth of a living child. CONCLUSION: Appropriate treatment appears to improve the prognosis for pregnancies in patients with APS. These patients are nevertheless at increased risk of an obstetrical event and require close monitoring, especially in obstetrical manifestations, which appear to have a poorer prognosis. Multidisciplinary follow-up by an experienced team is essential.


Assuntos
Síndrome Antifosfolipídica/classificação , Síndrome Antifosfolipídica/diagnóstico , Complicações na Gravidez/diagnóstico , Resultado da Gravidez , Adulto , Síndrome Antifosfolipídica/epidemiologia , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Prognóstico , Adulto Jovem
11.
Int J Immunopathol Pharmacol ; 27(3): 429-32, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25280034

RESUMO

Obstetric antiphospholipid antibody syndrome (APS), is well defined by classification criteria. It is well known that women with APS should receive prophylactic anticoagulation therapy with subcutaneous low weight heparin all throughout pregnancy and in the first 6 weeks postpartum. However, the optimal treatment for pregnant women having positive anti-phospholipid antibodies, but not fulfilling classification criteria for APS is still unclear. In this retrospective study we report pregnancy outcomes of 10 patients affected by recurrent miscarriages and positive anti-cardiolipin or aß2GP1 antibodies with titers ranging from 10 to 20 GPL/MPL demonstrated at least twice before pregnancy.


Assuntos
Aborto Habitual/imunologia , Síndrome Antifosfolipídica/classificação , Complicações na Gravidez/imunologia , Adulto , Anticorpos Antifosfolipídeos/sangue , Síndrome Antifosfolipídica/imunologia , Cardiolipinas/imunologia , Feminino , Humanos , Gravidez , Estudos Retrospectivos , beta 2-Glicoproteína I/imunologia
12.
Lupus ; 23(12): 1283-5, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25228727

RESUMO

The Task Force on Catastrophic Antiphospholipid Syndrome (CAPS) aimed to assess the current knowledge on pathogenesis, clinical and laboratory features, diagnosis and classification, precipitating factors and treatment of CAPS. This article summarizes the main aspects of its final report.


Assuntos
Síndrome Antifosfolipídica/etiologia , Comitês Consultivos , Síndrome Antifosfolipídica/classificação , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/tratamento farmacológico , Humanos
13.
Pathology ; 46(6): 481-95, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25158812

RESUMO

The antiphospholipid (antibody) syndrome (APS) is an autoimmune condition characterised by a wide range of clinical features, but primarily identified as thrombotic and/or obstetric related adverse events. APS is associated with the presence of antiphospholipid antibodies (aPL), including the so-called lupus anticoagulant (LA). These aPL are heterogeneous in nature, detected with varying sensitivity and specificity by a diverse range of laboratory tests. All these tests are unfortunately imperfect, suffer from poor assay reproducibility (inter-method and inter-laboratory) and a lack of standardisation and harmonisation. Clinicians and laboratory personnel may struggle to keep abreast of these factors, as well as the expanding range of available aPL tests, and consequent result interpretation. Therefore, APS remains a significant diagnostic challenge for many clinicians across a wide range of clinical specialities, due to these issues related to laboratory testing as well as the ever-expanding range of reported clinical manifestations. This review is primarily focussed on issues related to laboratory testing for APS in regards to the currently available assays, and summarises recent international consensus guidelines for aPL testing, both for the liquid phase functional LA assays and the solid phase assays (anticardiolipin and anti-beta-2-Glycoprotein-I).


Assuntos
Anticorpos Antifosfolipídeos/análise , Síndrome Antifosfolipídica/diagnóstico , Algoritmos , Anticorpos Anticardiolipina/análise , Síndrome Antifosfolipídica/classificação , Síndrome Antifosfolipídica/imunologia , Técnicas de Laboratório Clínico , Feminino , Guias como Assunto , Humanos , Fatores Imunológicos/análise , Inibidor de Coagulação do Lúpus/análise , Gravidez , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Trombose/diagnóstico , Trombose/imunologia , beta 2-Glicoproteína I/análise
14.
Lupus ; 23(10): 986-93, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24729280

RESUMO

OBJECTIVE: YB current affiliation: Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, Israel YB and MJS contributed equally to the study and should be regarded as joint first authors on this manuscript. Antiphospholipid syndrome (APS) may present with thrombosis and persistently elevated titers of antiphospholipid antibodies (aPL) in the neonatal period. Our aim was to investigate the course and impact of elevated titers of aPL in a cohort of infants presenting with either perinatal arterial ischemic stroke (PAS) or cerebral sinus vein thrombosis (CSVT) during the perinatal period. STUDY DESIGN: Sixty-two infants with clinically and radiologically confirmed PAS or CSVT presenting in the neonatal period underwent thrombophilia workup that included Factor V Leiden (FVL), PII20210A mutation, MTHFR 677T polymorphism, protein C, protein S, aPL namely either circulating lupus anticoagulant (CLA), anticardiolipin antibodies (aCL) or anti-ß2-glycoprotein-1 (ß2GP1). Mothers also underwent thrombophilia workup. RESULTS: Twelve infants with persistently elevated aPL were prospectively followed. Infants with positive aPL showed no concordance with presence of maternal aPL. All children were followed for a median of 3.5 years (range: nine months to 19 years) with repeated aPL testing every three to six months. Anticoagulant therapy initiation and therapy duration varied at the physician's discretion. In 10/12 cases aPL decreased to normal range within 2.5 years; one female with complex thrombophilia risk factors required indefinite prolonged anticoagulation. None of the infants showed recurrent thrombosis or any other APS manifestations, despite lack of prolonged anticoagulation. CONCLUSIONS: The presence of aPL may be important in the pathogenesis of cerebral thrombosis in neonates. Nevertheless, the nature of thrombophilia interactions in this period and their therapeutic impact warrants further investigation.


Assuntos
Anticorpos Antifosfolipídeos/sangue , Síndrome Antifosfolipídica/imunologia , Isquemia Encefálica/imunologia , Doenças do Recém-Nascido/imunologia , Trombose dos Seios Intracranianos/imunologia , Acidente Vascular Cerebral/imunologia , Adolescente , Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/classificação , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/tratamento farmacológico , Biomarcadores/sangue , Isquemia Encefálica/sangue , Isquemia Encefálica/classificação , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/prevenção & controle , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/sangue , Doenças do Recém-Nascido/classificação , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/tratamento farmacológico , Israel , Masculino , Estudos Prospectivos , Recidiva , Sistema de Registros , Fatores de Risco , Trombose dos Seios Intracranianos/sangue , Trombose dos Seios Intracranianos/classificação , Trombose dos Seios Intracranianos/diagnóstico , Trombose dos Seios Intracranianos/prevenção & controle , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/prevenção & controle , Trombofilia/sangue , Trombofilia/diagnóstico , Trombofilia/imunologia , Fatores de Tempo , Resultado do Tratamento , Regulação para Cima , Adulto Jovem
15.
J Autoimmun ; 48-49: 20-5, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24461539

RESUMO

The antiphospholipid syndrome (APS) is defined by the occurrence of venous and arterial thromboses, often multiple, and recurrent fetal losses, frequently accompanied by a moderate thrombocytopenia, in the presence of antiphospholipid antibodies (aPL). Some estimates indicate that the incidence of the APS is around 5 new cases per 100,000 persons per year and the prevalence around 40-50 cases per 100,000 persons. The aPL are positive in approximately 13% of patients with stroke, 11% with myocardial infarction, 9.5% of patients with deep vein thrombosis and 6% of patients with pregnancy morbidity. The original classification criteria for the APS were formulated at a workshop in Sapporo, Japan, in 1998, during the 8th International Congress on aPL. The Sapporo criteria, as they are often called, were revised at another workshop in Sydney, Australia, in 2004, during the 11th International Congress on aPL. At least one clinical (vascular thrombosis or pregnancy morbidity) and one laboratory (anticardiolipin antibodies, lupus anticoagulant or anti-ß2-glycoprotein I antibodies) criterion had to be met for the classification of APS.


Assuntos
Anticorpos Antifosfolipídeos/efeitos adversos , Síndrome Antifosfolipídica/classificação , Síndrome Antifosfolipídica/diagnóstico , Anticorpos Antifosfolipídeos/sangue , Síndrome Antifosfolipídica/imunologia , Doença Catastrófica/classificação , Doença Catastrófica/epidemiologia , Humanos , Incidência , Inibidor de Coagulação do Lúpus/efeitos adversos , Inibidor de Coagulação do Lúpus/sangue , Prevalência , Sistema de Registros , Trombose/classificação , Trombose/diagnóstico , Trombose/imunologia
17.
Rev. méd. Chile ; 141(8): 1068-1071, ago. 2013. tab
Artigo em Inglês | LILACS | ID: lil-698707

RESUMO

Neurofibromatosis type I (NF1) has been only rarely reported in association with anti-phospholipid syndrome (APS). We report a 38 year-old female with NF1, who developed a cervix carcinoma at the age of 30 years and was successfully treated with conization, without requiring chemotherapy or radiation. She experienced two miscarriages prior to the diagnosis of the carcinoma. When she was 38 years old, an APS was diagnosed based on repeatedly positive lupus anticoagulant tests. The patient continued to smoke and using oral contraceptives. At 38 years of age she had a myocardial infarction, despite the use of oral anticoagulation. She required coronary stenting. Aspirin and clopidrogel were indicated thereafter.


Es inusual la asociación entre neurofibromatosis tipo I (NF1) y síndrome antifosfolípidos (APS). Presentamos una paciente mujer de 38 años con un NF1 que desarrolló un cáncer cervicouterino a los 30 años y que fue tratada exitosamente con una conización, sin requerir quimioterapia o radiación. La paciente tuvo dos abortos espontáneos antes del diagnóstico del carcinoma. A los 38 años, se le diagnosticó un APS, basado en pruebas de anticoagulante lúpico que resultaron positivas en repetidas oportunidades. La paciente continuó fumando y usando contraceptivos orales y, a pesar de estar con anticoagulantes orales, tuvo un infarto agudo de miocardio a los 38 años. Se colocó un stent coronario y se indicó aspirina y clopidogrel.


Assuntos
Adulto , Feminino , Humanos , Síndrome Antifosfolipídica/complicações , Neurofibromatose 1/complicações , Síndrome Antifosfolipídica/classificação , Síndrome Antifosfolipídica/diagnóstico , Infarto do Miocárdio/complicações , Neurofibromatose 1/diagnóstico , Fatores de Risco
18.
Rev Med Chil ; 141(8): 1068-71, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24448865

RESUMO

Neurofibromatosis type I (NF1) has been only rarely reported in association with anti-phospholipid syndrome (APS). We report a 38 year-old female with NF1, who developed a cervix carcinoma at the age of 30 years and was successfully treated with conization, without requiring chemotherapy or radiation. She experienced two miscarriages prior to the diagnosis of the carcinoma. When she was 38 years old, an APS was diagnosed based on repeatedly positive lupus anticoagulant tests. The patient continued to smoke and using oral contraceptives. At 38 years of age she had a myocardial infarction, despite the use of oral anticoagulation. She required coronary stenting. Aspirin and clopidogrel were indicated thereafter.


Assuntos
Síndrome Antifosfolipídica/complicações , Neurofibromatose 1/complicações , Adulto , Síndrome Antifosfolipídica/classificação , Síndrome Antifosfolipídica/diagnóstico , Feminino , Humanos , Infarto do Miocárdio/complicações , Neurofibromatose 1/diagnóstico , Fatores de Risco
19.
Autoimmun Rev ; 11(11): 821-6, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23006529

RESUMO

Detection of anti-phospholipid (aPL) antibodies for state-of-the art diagnosis of antiphospholipid syndrome(APS) still remains a laboratory challenge due to the great diversity of aPL antibodies and their relevance with regard to the diagnostic criteria. According to the recently revised classification criteria for APS, several enzyme-linked immunosorbent assays (ELISAs) should be performed simultaneously in routine laboratories for the detection of aPL antibodies. Therefore, new approaches to aPL profiling have been proposed recently to provide information regarding diagnosis and eventually outcome in APS patients. Multiplex analysis could meet the increasing demand for cost-efficient detection and profiling of aPL antibodies. Multi-line immunodot assays or bead-based multiplex techniques candidate as alternatives to assess several aPL antibodies simultaneously employing different solid-phases for bound/free separation of reactants. Particularly, multi-line immunodot assays present an alternative to ELISA for aPL antibody detection and profiling in APS patients. The use of hydrophobic membranes as solid-surface by this technique appears to offer a distinct solid-phase reaction environment for the assessment of aPL antibodies. This article reviews novel developments in the field of laboratory diagnostics of APS with special emphasis on multiplex assays.


Assuntos
Anticorpos Antifosfolipídeos/sangue , Síndrome Antifosfolipídica/diagnóstico , Anticorpos Antifosfolipídeos/imunologia , Síndrome Antifosfolipídica/classificação , Síndrome Antifosfolipídica/imunologia , Humanos , Testes Imunológicos/métodos , Testes Imunológicos/normas
20.
Hum Reprod Update ; 18(5): 474-84, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22699010

RESUMO

In 1987, Nigel Harris cautioned against over-diagnosing the antiphospholipid syndrome (APS). In what was a rather prophetic editorial titled 'The Syndrome of the Black Swan', he suggested that while patients with APS do indeed exist, they are probably much more unusual than many medical professionals might like to believe. He expressed concern that the value of studying antiphospholipid antibodies (aPLs) as interesting non-organ specific autoantibodies, would become lost in a 'sea of over-interpreted and over-reported laboratory and clinical findings'. It is our contention that 25 years later, this prediction has come to pass, particularly with respect to one type of aPL and its relation to a clinical event, namely anticardiolipin antibodies and early recurrent pregnancy loss. In this commentary, we trace the evolution of the current dogma and propose that reevaluation of available data from an alternative perspective results in quite a different understanding, the acceptance of which would necessitate not only a revision of the classification criteria for APS but also the subsequent revision of many diagnoses.


Assuntos
Anticorpos Anticardiolipina/imunologia , Síndrome Antifosfolipídica/classificação , Síndrome Antifosfolipídica/diagnóstico , Perda do Embrião/imunologia , Anticorpos Anticardiolipina/sangue , Síndrome Antifosfolipídica/sangue , Perda do Embrião/sangue , Feminino , Humanos , Gravidez , Recidiva
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