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Immunology: Antiphospholipid antibodies and β2-glycoprotein-I in 500 women with recurrent miscarriage: results of a comprehensive screening approach
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1995
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ImmunohematologyImmunodeficienciesReproductive HealthImmunologyGynecologyPathologyAntiphospholipid AntibodiesImmunotherapyHigh-risk PregnancyMiscarriage TestingHematologyObstetricsPublic HealthAutoimmune DiseaseMaternal HealthImmunoglobulin GAutoimmunityMaternal-fetal MedicineImmunoglobulin MAntibody ScreeningLupusRecurrent MiscarriageMedicineWomen's HealthComprehensive Screening Approach
All women with a history of recurrent miscarriage should be screened for both lupus anticoagulant and anticardiolipin antibodies, and a second confirmatory test is required for any initial positive result. The study screened 500 women for lupus anticoagulant and anticardiolipin antibodies, using the dilute Russell’s viper venom time, which proved more sensitive for detecting lupus anticoagulant than activated partial thromboplastin time or kaolin clotting time. Among the participants, 9.6 % had persistently positive lupus anticoagulant and 3.3 %/2.2 % had IgG/IgM anticardiolipin antibodies, with only 1.4 % double‑positive; repeat testing confirmed persistence in 65.7 % of lupus anticoagulant, 36.6 % of IgG anticardiolipin, and 36.0 % of IgM anticardiolipin cases, and no differences were observed in gestational age of prior miscarriages or beta‑2‑glycoprotein‑I levels between antibody‑positive and –negative groups.
Five hundred consecutive women (median age 33 years; range 19-45) with a history of recurrent miscarriage (median 4; range 3-16) were screened for the presence of antiphospholipid antibodies (APA)-lupus anticoagulant (LA) and/or anticardiolipin antibodies (ACA). The prevalence of persistently positive tests for LA was 9.6% and for immunoglobulin G (IgG) and immunoglobulin M (IgM) ACA was 3.3 and 2.2% respectively. Only seven women (1.4%) were LA and ACA positive. Repeat testing, after an interval of at least 8 weeks, demonstrated that only 65.7% of LA positive, 36.6% IgG ACA positive and 36.0% IgM ACA positive women on initial testing had a second positive test result. The dilute Russell's viper venom time detected the LA significantly more often than either the activated partial thromboplastin time or the kaolin clotting time (P < 0.001). There was no difference in the gestation of previous miscarriages between APA positive and APA negative women. There was no difference in the plasma beta 2-glycoprotein-I concentrations between APA positive and APA negative women with miscarriages and normal women. All women with a history of recurrent miscarriage should be tested for the presence of both LA and ACA. A second confirmatory test should be performed in those with an initial positive test result.