Indian Journal of Medical Sciences Medknow Publications on behalf of Indian Journal of Medical Sciences Trust ISSN: 0019-5359 EISSN: 1998-3654 Vol. 61, Num. 12, 2007, pp. 663-664

Indian Journal of Medical Sciences, Vol. 61, No. 12, December, 2007, pp. 663-664

Letter To Editor

Significance of antiphospholipid antibodies in patients with bad obstetric history

Mishra MN, Gupta Sapna, Gupta MK

Department of Pathology, INHS Asvini, Colaba, Mumbai
Correspondence Address: Dr. Mahendra Narain Mishra, Hospital Laboratory, 166 Military Hospital, C/O56 APO, India. E-mail: mnmishra@hotmail.com

Code Number: ms07107

Sir,

Antiphospholipid antibody syndrome (APAS) is an autoimmune condition that may manifest with fetal loss, thrombosis or autoimmune thrombocytopenia. We share here our experience on prevalence of two clinically most relevant antiphospholipid antibodies (APL) - anticardiolipin antibodies (ACL) and lupus anticoagulants (LA) - and the response to treatment with low-dose Aspirin in 120 patients with bad obstetric history. Inclusion criteria for patients were history of three or more spontaneous abortions or/ and two or more stillbirths with a normal embryonic ultrasound at 6-8 weeks of gestation and negative TORCH serology. Controls comprised of 60 healthy women with at least one successful pregnancy and without previous history of abortion- or pregnancy-associated complications. Sample collection and testing was done, as described by Kumar et al.,^[1] after 12 weeks of miscarriage/ stillbirth in nonpregnant state. Statistical analysis of accrued data was done using EpiInfo 6 software. Probability 'P' values were calculated using chi-square test.

Our results showed that 34/120 (28.3%) and 9/60 (15%) patients tested positive for ACL and LA respectively, which includes three samples that were positive for both as per Brandt's criteria. ^[2] Clinical and laboratory profile of patients is shown in [Table - 1]. The titer of ACL was higher than 80 GPL units / liter (L) in two patients only. Increasing age and higher number of conceptions were observed to be more frequently associated with APL. Three controls had ACL of IgG isotype in the range 10-14 GPL units/L, but none tested positive for LA. Statistically both LA (P = 0.0014) and ACL (P = 0.0005) were found to be significantly related to bad obstetrical outcome. During the study period 55% of the women, who were put on aspirin therapy (75 mg/day), conceived and had uneventful delivery.

APAS has emerged as the most important treatable cause of recurrent miscarriage, early onset preeclampsia and of intrauterine growth restriction. [Table - 2] shows a comparison of this study with some others in contemporary Indian literature. Silver et al. found women with IgG A CL> 80 GPL/L had 40% fetal death, while women with IgG ACL < 40 GPL/L had less than 20% fetal wastage. ^[3] In our study, ACL positivity was present in three controls (5%); only two patient samples had titers exceeding 80 GPL units/L. In a study by Srikrishna et al. on 72 patients with obstetric complications with high titer (> 80 GPL units/L) in none of the patients. ^[5] Possibly, majority of Indian population with BOH (bad obstetric history) do not produce high titers of ACL. Usually low titers of IgM and IgG ACL are not associated with poor fetal outcome, and there is a legitimate argument for closely monitoring but not arbitrarily treating women with low ACL titers. There is a requirement for studying baseline levels of ACL in Indian population, and more studies are needed in women with BOH with APAS to account for geographical and genetic variations for determining significant levels and deciding whom to treat.^[6]

Acknowledgment

References

Copyright 2007 - Indian Journal of Medical Sciences

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