RRML - Lupus anticoagulant in children – a confounding factor in diagnosis and targeted therapy

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Nr. 29(3)/2021 DOI:10.2478/rrlm-2021-0021

Research article

Lupus anticoagulant in children – a confounding factor in diagnosis and targeted therapy

Cristian Jinca, Margit Serban, Emilia Ursu, Nicoleta Anamaria Pascalau, Oana Belei, Delia Savescu, Mihaela Lelik, Andrei Ioan Munteanu, Andreas Tiede, Smaranda Arghirescu

Correspondence should be addressed to: Cristian Jinca

Abstract:

Introduction: Lupus anticoagulant (LAC) belongs to a heterogeneous group of antibodies directed against negatively charged phospholipid-binding proteins, inhibiting phospholipid-dependent reactions. We assessed the frequency, etiological background, clinical and biological expression as well as the appropriate management and outcome of LAC in a pediatric population. Patients and methods: We included 19 pediatric patients diagnosed with a positive LAC test during a period of 1 year. LAC detection was carried out according to the ISTH/SCC guidelines 2012. Coagulometric assays were performed in order to check for coagulation factor activities. The presence of specific inhibitors has been tested by the Bethesda assay. Results: LAC was positive in 0.4% of the patients monitored for increased activated partial thromboplastin time (aPTT) during the study period of 1 year. In contrast to the asymptomatic clinical image presented by the majority of our patients, the biological picture was dominated by an elevated aPTT (79 %), the aPTT ratio correlating significantly with the strength of LAC. In 58 % of the patients LAC became negative within 12 weeks, in another 4 (21%) patients within 20 weeks, whereas in 4 (21%) patients LAC remained positive throughout the follow-up. Conclusion: Albeit usually innocent in asymptomatic patients, LAC needs to be seriously taken into consideration from the diagnostic point of view in order to avoid dangerous therapeutic attitudes.

Keywords: antiphospholipid syndrome, acquired hemophilia, activated partial thromboplastin time, lupus anticoagulant

Received: 19.3.2021
Accepted: 21.6.2021
Published: 10.7.2021

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Jinca C, Serban M, Ursu E, Pascalau NA, Belei O, Savescu D, et al. Lupus anticoagulant in children – a confounding factor in diagnosis and targeted therapy. Rev Romana Med Lab. 2021;29(3):287-98. DOI:10.2478/rrlm-2021-0021