Many expectant mothers wonder what a lupus anticoagulant is? VA is a collection of autoantibodies. They are produced by the immune system. The body thus protects itself from its own phospholipids. For the first time, such antibodies were diagnosed in a person who suffered from lupus erythematosus.

A lupus anticoagulant test is needed to identify the causes of bleeding disorders.

An anticoagulant test is a blood draw that is performed to identify antiphospholipid syndrome and the sources of its occurrence. Such reasons very often provoke abortions, and cases of thrombosis are not uncommon. Such a blood test is usually prescribed by therapists, gynecologists, rheumatologists, immunologists, cardiologists and reproductive specialists during the IVF process.

The results of anticoagulant tests include blood clotting indicators. If the result is positive and VA is present in the blood, doctors will need to prescribe a mandatory examination of the patient.

If the test for lupus anticoagulant is positive, there is a high probability of thrombosis in any area circulatory system.

VA present in the body significantly impairs the activity of prothrombin. It is responsible for the ability of blood clotting. However, the main factors responsible for the development of antibodies are not yet known. As doctors themselves suggest, this includes problems, malfunctions that are associated with the immune system, or the presence of infectious diseases.

When should you get tested?

Blood testing for an anticoagulant must be donated to the patient when he has received a referral to a gynecologist, rheumatologist, as well as a therapist or cardiologist. Such an analysis is a routine study necessary to determine the composition of the blood.

If the test result shows a prolonged aPTT (activated partial thromboplastin time), this is a sign that there may be lupus anticoagulant in the blood. This means that the time it takes for a blood clot to form immediately after administration of the reagent increases.

APTT is calculated differently in each laboratory based on the equipment. Each device has its own standards. The results of the APTT analysis must be compared with the reference (normal) values ​​indicated opposite the result.

The normal APTT ranges from 21 to 35 seconds.

The paradox associated with thrombosis in people with VA has not yet been resolved. It would seem that the blood clotting time increases, but thrombosis still appears. Although it is known that blood clots appear due to thick blood. Doctors still don’t know how and why this happens.

Symptoms of VA:

1. Symptoms of venous and arterial thrombosis, disruptions in the circulatory system, ischemic stroke.
2. Decreased platelet content in the bone marrow.
3. Miscarriage in most cases, frequent miscarriages, as well as intrauterine death of the baby.
4. Increased APTT volume.
5. Antiphospholipid syndrome (screening).
6. If anticardiolipin antibodies were detected.

If the lupus anticoagulant in the blood exceeds the level, the patient may be unable to continue bearing the baby.

Normal and weakly positive result

If the composition contains lupus antibodies, then this indicates the likelihood of antiphospholipid syndrome. Such a serious pathology provokes increased formation of blood clots!

There is no single analysis. To conduct analyses, several research methods are used at once. Therefore, the results may be different meanings. The norm is the time from 31.00 to 44.00 seconds. This indicator is sometimes counted as 1 conventional unit.

Example of a normal lupus anticoagulant test. Pay attention to the reference (normal) values; they may differ from laboratory to laboratory depending on the equipment used and the research method.

If the lupus anticoagulant is negative, it means that the ingredient is not in the blood. If no VAs were detected during testing, then antiphospholipid syndrome And autoimmune diseases completely absent. A negative result is the best. This means that the woman will be able to carry the baby and give birth without complications.

If the lupus anticoagulant is weakly positive, then the indicators vary from 1.3 to 1.5 c.u. This value demonstrates that there is VA in the blood, but in small quantities. His activity is low.

What does a positive lupus anticoagulant mean in tests?

A positive anticoagulant is an indicator of the presence of the following diseases and complications:

• systemic lupus erythematosus;
• APS syndrome;
• rheumatoid arthritis;
• tumors of various types;
• ulcerative colitis;
• multiple myeloma;
• complications after taking certain medications;
• various infectious pathologies.

If during pregnancy the lupus coagulant is positive, doctors may suggest an abortion. Childbirth, with such tests, can end very sadly.

False positive result

As is already known, complications after taking certain medications can show a positive result when tested for VA. However, these results may be false positives. For example, if a patient is undergoing anticoagulation therapy (heparin or heparin replacement) and is tested for lupus anticoagulant, then the result may be false positive. Therefore, to ensure accurate results, you should stop taking (hirudin, danaparoid or argatroban) before taking the test.

Attention! You can stop taking medications only with doctor's permission! It is very important. Adoption independent decisions can lead to serious consequences!

Conception, gestation and childbirth with positive VA

A positive VA in a woman means the presence of APS (antiphospholipid syndrome). If this pathology detected even before conception, then after a course of treatment you can become pregnant and not be afraid of complications. Pregnancy planning allows you to properly prepare for pregnancy and avoid risks. Don't neglect this opportunity.

You need to prepare for pregnancy. You need to get tested for lupus anticoagulant. This is very important analysis. You need to do it before you decide to get pregnant.

If a woman plans to become a mother, testing for the presence of lupus anticoagulant is necessary. Such an analysis is also required. Such an analysis is always prescribed to expectant mothers if the following cases have occurred:

1. Frozen pregnancy.
2. Miscarriages.
3. Fetal death occurred over a long period of time.
4. Feeling constant migraines.
5. Decreased vision.
6. Blueness, numbness of fingertips.

When pregnant, the body begins to intensively reorganize itself, preparing for future births. At the same time, the rate of blood clotting begins to increase.

If a woman has a positive result for VA, this is reflected as follows:

• damage to the placenta begins;
• the fetus may develop hypoxia;
• fetal death may occur.

A woman begins irreversible processes that are associated with cardiovascular system. In addition, there is a high risk of developing a stroke renal failure, pulmonary embolism. That is why therapy should be started as early as possible. There is no way to delay treatment.

Treatment

The duration of therapy is, on average, 3 months. After completing the course of treatment, you should take control tests. If the therapy was successful, it is stopped. In order for the treatment to be effective, the patient will need to abandon the existing way of life. First of all, you need to give up smoking, fatty foods, and drink more fluids.

Anticoagulant therapy is prescribed:

1. If APS has been diagnosed, heparin, warfarin and aspirin will be prescribed.
2. If rheumatoid diseases are detected, dexamethasone and prednisolone will be prescribed.
3. Additionally, blood purification is carried out using plasmapheresis.

If available excess weight, then you need to decide this problem. You should pay attention to the fact that there are foods that contain a lot of vitamin K. When excessive consumption This vitamin increases the likelihood of thrombosis many times over. If we add the presence of lupus anticoagulant in the body, this is even dangerous. Therefore, it is important to follow a diet during treatment agreed with your doctor. It is necessary to exclude prunes, dried apricots, greens, baked potatoes, and cabbage from the diet.

Don't forget about beneficial properties physical exercise. Sport - is life! There is no need to throw yourself behind a barbell or dumbbells and torment yourself with brutal, hours-long workouts. It is enough to take walks at a brisk pace fresh air 2-3 times a week for 40-50 minutes. Swimming is especially recommended. Active image life significantly improves the condition of the blood, its viscosity and coagulability.

Write your VA indicators in the comments. What treatment were you prescribed? Our specialists will be able to comment on your treatment or give advice. Don't forget to rate the article with stars. Share this article in your in social networks with friends. Thanks for visiting. Don't let your tests upset you. We wish you good health.

Even if you were lucky enough to watch just one episode of the famous medical series House, you should have learned about this disease. We're talking about lupus erythematosus, of course! Many people only learned about this disease from the series, but in fact, lupus erythematosus is much closer than it might seem...

What is lupus anticoagulant and what is its rate?

– IgG antibodies against blood enzymes and phospholipids. Immunoglobulin received this specific name due to the fact that it was first found in the blood of patients suffering from systemic lupus erythematosus.

Lupus anticoagulant(VA) in the body suppresses the action of the protein prothrombin, the most important element responsible for blood clotting. By the way, the presence of a lupus anticoagulant in the blood does not mean that a person has lupus erythematosus.

The exact reason for the appearance of BA antibodies in the body has not been identified, but most likely, problems with the immune system and past infectious diseases contribute to this.

Even in healthy body tests may reveal lupus anticoagulant, but there is no need to worry about this if its level does not exceed the norm. Safe for health norm of lupus coagulant, established by doctors: from 0.8 to 1.2 conventional units.

When are tests to detect lupus anticoagulant prescribed?

Tests showing the presence of lupus coagulant in the blood are classified as non-standard. These are special studies that are usually done only as prescribed by a doctor.

Doctors prescribe a test for the presence of lupus anticoagulant in the following cases:

1. This is one of the main tests when examining pregnant women.
2. VA tests are taken for venous and arterial thrombosis.
3. Diagnosis of APS syndrome will also require data on the presence of VA in the blood.
4. If a person suffers from constant autoimmune diseases, you should also check your body for the presence of lupus anticoagulant.

Laboratories that can test for the presence of lupus anticoagulant are usually private centers that serve patients at reasonable prices.

Before taking the analysis, you should prepare:

1. The analysis is given on an empty stomach.
2. At the time of the test, the patient should not be taking medications. Otherwise, you need to indicate what is being taken and in what doses.
3. Treatment aimed at normalizing the level of lupus anticoagulant may be incorrect if the patient drank alcohol before the test, fatty foods, physically overexerted (analysis may show inaccurate data in this case).

What to do if lupus anticoagulant is positive/negative?

The most ideal test result is a lupus anticoagulant level below or within the normal range. But even in this case, it is best to get tested again. You can be one hundred percent sure of the results only after two or three tests - this is a rather specific “infection”. The same applies to a positive result, By the way, you can breathe a sigh of relief only after several satisfactory results.

If tests show that the lupus anticoagulant is still elevated, this may mean that the patient suffers from APS (antiphospholipid) syndrome, systemic lupus erythematosus, rheumatoid arthritis, ulcerative colitis, multiple myeloma. Put accurate diagnosis only a professional should. He will also help you choose the appropriate treatment - under no circumstances should you lower the level of lupus anticoagulant on your own!

Lupus anticoagulant - how dangerous is it?

The blood coagulation system can be influenced by many indicators, which are determined by biochemical analysis blood and coagulogram studies, but in any case, you need to remember that all indicators must be assessed by a doctor and based only on the assessment of one indicator, but on the results of a comprehensive study. In some cases, to assess the blood coagulation and anticoagulation systems, it is necessary to perform immunological tests, for example, donate blood for antibodies to cardiolipin and lupus anticoagulant.

What is lupus anticoagulant and its significance in the human body

IN normal conditions the coagulation and anticoagulation systems of the blood are in balance - due to this, the fluidity of the blood is maintained in blood vessels in the absence of damage and the formation of a blood clot in injuries and wounds of any location. Accordingly, with an increase in the concentration of some substances in the blood serum, there should be a compensatory increase in others - only in this case is it possible to prevent thrombosis. But the human body can compensate for these changes only to a certain limit, after which there comes a moment when even an existing tendency to thrombosis can become a cause of bleeding - the factors responsible for blood clotting simply will not remain in the serum. Lupus anticoagulant is one of the substances that can cause coagulation disorders. special substance protein nature, which refers to human immunoglobulins.

These antibodies, as well as antibodies to cardiolipins and phospholipids in general, are produced in the cells of the immune system and most often these substances are found in the blood of patients with various autoimmune diseases. But the problem is also that lupus anticoagulant, positive during pregnancy, can cause the development various complications both from the pregnant woman and from the fetus. You need to understand that the detection of lupus anticoagulant in the absence of antibodies to various DNA of the patient’s body, phospholipids, cardiolipin only indicates the possibility of the development of these side effects and the need for constant medical supervision of the patient.

It must be remembered that lupus anticoagulant, the norm of which in blood serum ranges from 0.8 to 1.2 conventional units, is not a sufficiently reliable indicator. Therefore, if an elevated level or even a questionable test result is detected, it is necessary to perform a comprehensive coagulogram with the obligatory determination of D-dimer, clotting time (APTT), and possibly large quantity research indicators - both the prognosis and tactics depend on this possible treatment patient.

Lupus anticoagulant - when research is necessary

Immediate blood testing for lupus anticoagulant may be required not only for pregnant women. This test is prescribed and performed on patients who have had arterial and venous thrombosis any localization, thromboembolism, sudden hemorrhagic or ischemic strokes without the presence of those diseases in which disorders can develop cerebral circulation (arterial hypertension, atherosclerotic cardiosclerosis). Special attention deserve young women who during their lifetime have had cases of sudden fetal death at any stage of pregnancy in the absence genetic diseases And intrauterine infection. Only with constant monitoring of coagulogram parameters, lupus coagulate, antibodies to phospholipids and cardiolipin can one select effective treatment– only in this case can the progression of coagulation disorders be prevented.

Lupus anticoagulant. Reasons for increasing its level in the blood, analysis and results

The state of the blood coagulation system and its components, which transmit their activity throughout the body, allows us to establish a special set of tests called a coagulogram. One of its indicators is lupus anticoagulant. It was first isolated from the blood of patients suffering from systemic lupus erythematosus, hence its name. This coagulogram indicator belongs to the IgG class immunoglobulins - a group of antibodies produced to neutralize the effects of phospholipids.

Antiphospholipid syndrome

Lupus anticoagulant helps suppress the reaction in the blood from converting prothrombin to thrombin. These antibodies are formed in the body as a consequence of the formation of autoimmune processes after any infectious influences. More often this is one of the main signs of APS (antiphospholipid syndrome). An increase in the amount of anticoagulants in a person’s blood is perceived as a risk factor, indicating the body’s predisposition to venous and arterial thrombosis and the manifestation of an autoimmune process. Lupus anticoagulant affects hemostatic parameters, since phospholipids participate in their formation. The mechanism of its action is to neutralize phospholipids, which have a negative charge, as well as their complexes with proteins involved in blood clotting.

The main symptom of APS

Antiphospholipid syndrome can manifest itself in completely different ways, depending on the degree of vascular damage, the size of the blood clot, its location and the rate of blockage of the blood vessels. The main symptom of APS is damage to the blood vessels of the skin, such as livedo reticularis. It is expressed as reticulate bluish-violet spots, most often located on the skin of the extremities, sometimes on chest. Their appearance is caused by stagnation of blood in venules, capillary surfaces, and microthrombosis. This pathology is also characterized by a feeling of pain, coldness, and changes in skin sensitivity. The disease may be complicated by swelling, and small areas of ulceration may also form in the affected areas.

Elevated anticoagulant levels

Increasing in quantity and affecting blood vessels, the lupus anticoagulant contributes to blockage of blood vessels, causing pulmonary thromboembolism, myocardial infarction, development of autoimmune diseases. Its elevated level may be a sign of systemic lupus erythematosus, ischemic cerebrovascular accidents, and AIDS.

Reasons for the development of pathology

TO causal factors the appearance of lupus anticoagulant include autoimmune disorders such as rheumatoid arthritis, multiple myeloma, systemic lupus erythematosus, ulcerative colitis, malignant tumors. These include secondary antiphospholipid syndrome and complications caused by drug therapy or taking certain medications.

Lupus anticoagulant test

Indications for the study are pathologies such as spider veins on the skin, venous and arterial thrombosis regardless of location, thromboembolism, persistent miscarriage, thrombocytopenia, false-positive Wassermann reaction, prolongation of aPTT without good reason, livedo reticularis and others. The material for analysis is blood plasma. Its results are formulated in the form of such relative judgments as positive (significantly, moderately, weakly) or negative.

Lupus anticoagulant during pregnancy

An increase in the blood anticoagulant during pregnancy can cause the development of placental vascular thrombosis. This condition can lead to premature birth, intrauterine fetal death. If there is a threat of miscarriage, a test for lupus anticoagulant is performed twice with a break of 6 or 8 weeks. Positive result(in both cases) along with such manifestations as thrombosis of arteries, veins, retinal vessels, stroke, heart attack and others, confirms the presence of antiphospholipid syndrome in a woman.
But it is worth noting that the presence of a group of antibodies in the blood can be explained by a number of factors. It is impossible to make a diagnosis based solely on the presence of lupus anticoagulant in the blood. Its norm is maintained at 0.8-1.2 conventional units. Deviations should only serve as a reason for a more thorough medical examination.

What is the normal level of lupus anticoagulant in the blood of pregnant women?

Yurkoff

Lupus anticoagulant (LA) is an IgG class immunoglobulin. Lupus anticoagulant is an antibody against phospholipids, blood enzymes. Lupus anticoagulant got its name due to the fact that it was first detected in the blood of patients with systemic lupus erythematosus.

A doctor may suspect the presence of lupus anticoagulant in the blood if, when the activated partial thromboplastin time (aPTT) is prolonged, which is typical when blood clotting slows, bleeding occurs and there is a risk of developing thrombosis.

The norm of lupus anticoagulant in the blood: 0.8-1.2 conventional units. units

Lupus anticoagulant and other antibodies to phospholipids are one of the main signs of the development of antiphospholipid syndrome (APS).

Lupus anticoagulants, increasing in quantity in human blood, attach to the walls of blood vessels, platelets, and enter into blood clotting reactions, provoking the development of thrombosis.

Depending on the size of the blood clot, the degree of damage to the vessel, the location, and the rate of blockage of the vessel, antiphospholipid syndrome can manifest itself differently. Most common symptom antiphospholipid syndrome - livedo reticularis - a thin network of blood vessels on the surface of the skin, which becomes better visible in the cold. Symptoms can even include ulcers and dead skin on the fingers or toes.

A small vascular lesion in APS will cause mild dysfunction of the organ, a large lesion will cause chronic diseases organs (liver cirrhosis, Alzheimer's disease). Blockage of a vessel by a blood clot will cause pulmonary thromboembolism. Antiphospholipid syndrome is one of the main causes of myocardial infarction in young people under 40 years of age.

Increased levels of lupus anticoagulant in the blood may be a sign of the following diseases:

Autoimmune diseases
systemic lupus erythematosus
infertility
AIDS
thromboembolism
ischemic cerebrovascular accidents.
In pregnant women, an increase in lupus anticoagulant in the blood can provoke the development of thrombosis of the placental arteries, which can cause intrauterine fetal death, miscarriage and premature birth.

Lupus anticoagulant in the blood may increase as a complication drug therapy and due to taking certain medications.

The definition of a lupus anticoagulant does not provide sufficient grounds for a doctor to make a particular diagnosis. The level of VA can change under the influence of various factors. Detection of a large number of lupus anticoagulants in the blood will indicate the need for additional examination.

Lupus anticoagulant in blood test healthy person should be practically absent. Its appearance, even in small quantities, should cause concern, since this fact indicates that the blood clotting time is disturbed.

Recall that blood clotting is extremely important aspect hemostasis. For any leaks vascular system(cuts, damage to blood vessels of any origin) come into play, which create blood clot(or clots) at the site of blood leakage. Thereby clogging the site of injury and preventing blood loss.

Under some circumstances a violation occurs complex process blood coagulation (clot formation), in which such an important indicator as clotting time deteriorates.

In terms of the direction of its action, VA is a complex of antibodies that:

• They trigger reactions against anionic phospholipids and associated proteins - essential structural components of platelet cell membranes, one of the functions of which is the activation of blood coagulation factors.
• Phospholipids-vitamin K-dependent blood clotting factors prevent the formation of complexes.

Because normal functioning hemostasis is impossible without phospholipids; with the development of antigen-antibody type reactions, the process of pathological thrombus formation and blood clotting disorders starts.

Important. Despite the prolongation of clotting time when the lupus anticoagulant is activated, the entire process is accompanied by increased thrombus formation in arteries and veins of various sizes and levels of localization, which is the result of the development of pathological reactions.

Mechanism of action of VA

With the development of a number of autoimmune processes in the body, which can lead to increased levels of lupus anticoagulant,
reactions are launched against their own cells:

• More often pathological condition begins with development in the human body infectious process, predominantly of viral or bacterial etiology.
• Impairment of an adequate immune response leads to autoimmune reactions against one’s own body, which causes the appearance of self-antigen (in this case, phospholipids)-antibody complexes.
• The amount of protein components (namely lupus anticoagulants) that attack phospholipids and block their normal functions increases.
• VA begins to suppress the transformation of prothrombin into thrombin.
• An increase in blood clotting time develops.
• In response to such a reaction, an enhanced platelet response develops, which leads to widespread thrombosis, but, unfortunately, today this is only a hypothesis, since the mechanism of blood clot formation under the influence of VA is not fully understood.

For reference. Despite the difficulties in pathogenetic mechanisms, the definition of lupus anticoagulant carries a huge diagnostic value in identifying autoimmune diseases.

Diagnostic value

VA is currently a marker of the following processes:

• Diagnosis of antiphospholipid syndrome.
• Development of systemic autoimmune diseases in the body.
• Pathological formation of blood clots in the vessels of both arterial and venous beds of unknown origin.

Attention! The danger that the lupus anticoagulant is elevated in the blood of patients is that it is not possible to predict the location of blood clots.

To avoid development dangerous situations It is necessary to conduct blood tests for VA levels in certain groups of patients.

Indications for VA study

• Confirmation of availability and elevated levels VA.
• Diagnosis of antiphospholipid syndrome (carried out in combination with the determination of anticardiolipin antibodies and antibodies to beta-2-glycoprotein in the patient’s blood).
• Detection of anticardiolipin antibodies.
• Reduced platelet count.
• Diagnosis of systemic autoimmune diseases, primarily systemic lupus erythematosus.
• Primary and recurrent early venous and arterial thrombosis.
• Thromboembolism of various localizations.
• Myocardial infarction.
• Ischemic strokes, cerebral circulatory disorders, especially in persons under 45 years of age.
• Habitual miscarriage, stillbirth, frequent miscarriages, intrauterine fetal death.
• Pregnancy planning.
• Combinations of thrombosis with thrombocytopenia.
• Livedo reticularis (livedo reticularis, marbled skin).
• False-positive Wasserman reactions (test for syphilis).
• Increased APTT (activated partial thromboplastin time).
• Initiation of treatment with drugs from the group of indirect anticoagulants.

If there is at least one indication for a blood test for VA, it is necessary to immediately conduct an analysis on the patient in accordance with established standards.

Methods of analysis

Lupus anticoagulant is one of the indicators of blood clotting, which, according to indications, is included in
.

To conduct the study, a fence is taken venous blood on an empty stomach. To obtain accurate data, you must adhere to the following recommendations:

• A blood test for lupus anticoagulant is carried out on an empty stomach with the abolition of food and drink 12 hours before the test. Only non-carbonated water is allowed.
• Cancelled two weeks in advance medicines coumarin series.
• Two days before the study, do not take heparin-based drugs.

For more accurate diagnosis and staging correct diagnosis diseases it is recommended to carry out additional examination for definition:

• Antiphospholipid antibodies (APS-AT) IgM.
• APS-AT IgG.
• Antibodies to cardiolipin, IgM, IgG.
• Antibodies to beta-2-glycoprotein.
• Total IgG.

When testing blood for VA, factors such as:

• For hyperproteinemia, blood tests for lupus anticoagulant are performed every 2-4 weeks.
• Determination of false-positive blood test data for RW requires repeat testing to exclude or confirm the activity of the lupus anticoagulant.
• To diagnose antiphospholipid syndrome, at least two tests are required.

In general, when performing tests on patients with bleeding disorders and pathological formation thrombus The International Society of Thrombosis and Hemostasis requires diagnostics according to the established algorithm:

• Stage 1 is a screening test that is based on lengthening phospholipid-dependent coagulation tests.
• Stage 2 – correction test, the purpose of which is to establish the cause of the violation of the screening examination data.
• Stage 3 – confirmatory or final test to determine the nature of the inhibitor.

Even if the results of the study at the first stage are negative, this does not mean that there is no lupus anticoagulant in the blood. Only negative result with two analyzes allows for absence or values ​​in the range normal values lupus anticoagulant.

Only by using the correct research algorithm is it possible to correctly evaluate and decipher the data obtained.

Lupus anticoagulant. Norm

The results of the lupus anticoagulant test are interpreted as follows:

• Negative – VA is not detected in the blood, or is present within acceptable limits.
• Positive - lupus anticoagulant is detected in the blood above normal levels.

Depending on the degree of increase in VA in patients, the test can be:

• Weakly positive - indicators vary from 1.2 to 1.5 c.u. – activity is assessed as low.
• Moderate – from 1.5 to 2 c.u. – at this stage there is a risk of developing thrombosis.
• High – from 2 USD – high risk of thrombosis of any location.

Reasons for increasing VA

The main reasons for the appearance or increase in the concentration of lupus anticoagulant in the blood are:

• Antiphospholipid syndrome (comprehensive examination required).
• Systemic lupus erythematosus.
• Nonspecific ulcerative colitis.
• Multiple myeloma.
• Rheumatoid arthritis.
• Neoplasms of various localizations.
• Complications during treatment with certain groups of drugs.

Attention! It is necessary to take into account that it is impossible to make a diagnosis solely on the basis of the presence of VA in the blood, much less begin any treatment, since for everyone the specified disease it is necessary to use additional diagnostic procedures.

Lupus anticoagulant during pregnancy

The appearance of lupus anticoagulant or its increase above normal in pregnant women or women planning pregnancy, leads to:

• Difficulty conceiving.
• Infertility.
• Frequent miscarriages.
• Miscarriage.
• Fading pregnancy (intrauterine fetal death).
• Stillbirth.
• Death of a pregnant woman.

Detection of a lupus anticoagulant during pregnancy can lead not only to pathology of its course, but also to a risk to the fetus. This is also a huge risk for the woman herself, since a condition characterized by increased formation of blood clots can cause a heart attack, stroke, or lower limbs, thromboembolism even with timely treatment.

When planning a pregnancy and already having it, women are screened if they are at risk:

• History of thrombosis.
• Obstetric pathology in the form of frequent spontaneous abortions and miscarriages.
• Preeclampsia, eclampsia.

When testing blood for lupus anticoagulant in pregnant women, a test is performed to determine the levels and activity of the following indicators:

• Fibrinogen.
• Antithrombin III. platelets.
• Proteins C and S.
• D – dimer.
• Prothrombin mutations.

Determining treatment tactics for a pregnant woman requires a thorough diagnosis according to all standards with all required tests, as well as constant monitoring and monitoring of the condition.

Treatment

Lupus anticoagulant is not a disease. This is one of the symptoms of the disease, which must be treated after a thorough diagnosis and differential diagnosis sick.

Determination method Automatic coagulation analyzer using diluted Russell's viper venom.

Material under study Plasma (citrate)

One of the important screening and confirmatory tests for diagnosing antiphospholipid syndrome.

Lupus anticoagulant (LA) belongs to the IgG class of immunoglobulins. This is a group of antibodies against negatively charged phospholipids. It suppresses the reaction in the blood from converting prothrombin to thrombin. It is assumed that lupus anticoagulants are formed in the body mainly as a result of the development of autoimmune processes after infectious exposure. When the presence of these antibodies in the blood is detected by lengthening coagulation tests, they are defined as “lupus anticoagulant.” They received this name due to the fact that they were first identified in patients with SLE (systemic lupus erythematosus). The presence of lupus anticoagulant is often observed in antiphospholipid syndrome.

Lupus anticoagulant neutralizes negatively charged phospholipids and phospholipid-protein complexes involved in the blood clotting process. Its presence in the blood causes prolongation of in vitro clotting time in phospholipid-dependent coagulation tests (usually APTT, less often - prothrombin test). In conditions of a whole organism, the chronic presence of lupus anticoagulant in the blood, in contrast to antibodies to individual factors coagulation, is associated with a tendency to thrombosis. VA is an important indicator of the risk of thrombosis, especially in systemic, autoimmune diseases, antivospholipid syndrome, and in patients with AIDS. The presence of this type of antibody is associated with the risk of miscarriage.

Literature

1. Barkagan Z. S., Momot A. P. Diagnosis and controlled therapy of homeostasis disorders. - M.: Newdiamed, 2001. - 286 p.
2. Riley R., Friedine J., Rogers J. Antiphospholipid antibodies: standardization and testing/ Clin. Lab. Med. 1997, v. 17, p. 395 - 9.

The presence of lupus anticoagulant (LA) in the blood is one of the causes of recurrent miscarriage (miscarriage). There are many reasons for spontaneous abortion:

• genetic, with the development of chromosomal abnormalities;
• endocrine (lack of function corpus luteum ovaries, disorders of the thyroid gland);
• anatomical ( congenital anomalies development of the uterus or acquired defects, cervical insufficiency);
• infectious;
• unclear reason;
• immunological.

The latter are divided into alloimmune and autoimmune disorders. For alloimmune the immune system female body fights embryonic antigens received from the father.

If the immune system is aggressive towards the tissues of the body, that is, it perceives its own antigens as foreign, then we're talking about about autoimmune disorders. As a result, the maternal body is damaged, and the fetus suffers a second time.

During an autoimmune process, the following autoantibodies are detected in the blood serum:

• antithyroid;
• antinuclear;
• antiphospholipid when antiphospholipid syndrome (APS) develops. There are several varieties of the syndrome, one of the manifestations of which is the presence of VA in the blood.

Test for lupus anticoagulant during pregnancy: who needs it?

TO future pregnancy It is imperative to prepare and undergo a full inspection and examination. But if a woman goes to the antenatal clinic while pregnant, then when collecting anamnesis it is important to find out the presence of autoimmune diseases and evaluate the course and outcome of previous and current pregnancies

Analysis for VA is indicated in the following cases:

• if three or more spontaneous abortions occur in a row within a period of up to 22 weeks (this is called recurrent miscarriage). Miscarriages that occur before 12 weeks are called early, and from 12 to 22 weeks of pregnancy late;
• developing fetoplacental insufficiency and intrauterine fetal hypoxia;
• syndrome of retarded fetal growth and development;
• early development of gestosis, especially its severe forms;
• premature detachment of a normally located placenta;
• a reduced number of platelets was detected in the blood, but the reason is unclear;
• The Wasserman reaction (for the presence of syphilis) is false positive.

Lupus anticoagulant: normal during pregnancy

During pregnancy, screening is carried out, during which the lupus anticoagulant should not exceed standard indicators. There may be differences in each laboratory, but the average values ​​are presented in the table below:

Increased lupus anticoagulant during pregnancy

During pregnancy, a weakly positive lupus anticoagulant can be detected, then you need to take the test again, and after 3 weeks there may be a negative result. But in any case, this should alert the doctor and you will be prescribed additional examination:

• donate blood for antibodies to cardiolipin, beta-2-glycoprotein;
• monitor coagulogram data, where fibrinogen normally increases during pregnancy; APTT shortens and antithrombin III decreases. But with the development of an autoimmune process, the aPTT lengthens;
• from the second half of pregnancy, the functioning of the kidneys and liver is examined (the level of creatinine and urea is determined in the blood, which normally decrease; cholesterol increases; protein is determined in the urine);
• in the second trimester, sexually transmitted infections are treated and the condition of the cervix is ​​monitored;
• from 16 weeks, ultrasound is performed every month to monitor the rate of fetal growth and the amount of amniotic fluid;
• Dopplerometry and FCTG allows you to diagnose disorders, assess the condition of the fetus and select the timing;
• undergo consultation with a geneticist and hematologist.

It is necessary to monitor during childbirth, as there is a risk of developing acute fetal hypoxia against the background of chronic hypoxia, or placental abruption.

IN postpartum period There is a high risk of developing thromboembolism, so the condition of the postpartum woman is monitored and glucocorticosteroids are continued for another 2 weeks.

Before childbirth, during childbirth and on days 3-5 of the postpartum period, blood counts are monitored. If pronounced changes in the coagulation system are detected, heparin and aspirin are prescribed. In this case breast-feeding suppress and exclude.

If changes in the blood system are short-term and respond well to treatment, then lactation is stopped only at the time of treatment.

Treatment for high lupus anticoagulant during pregnancy

If the lupus anticoagulant is positive, treatment and monitoring over time must be carried out during pregnancy, which helps prevent serious complications from both the mother and the fetus.

There are several treatment regimens that can only be selected by a doctor.

Scheme No. 1. Glucocorticosteroids (prednisolone, dexamethosone)

Some researchers believe that prednisolone causes a considerable number of complications ( diabetes pregnant women, ulcers, osteoporosis, etc.), however, such consequences can be observed when using high doses prednisolone - up to 60 mg/day.

Long-term use of glucocorticosteroids leads to the activation of a bacterial-viral infection, which can lead to infection of the fetus. Therefore, human immunoglobulin is prescribed for prevention in each trimester.

Scheme No. 2. Anticoagulants (sodium heparin; low molecular weight heparins with active substance enoxaparin sodium, nadroparin calcium, dalteparin sodium)

In the first 3 weeks of therapy using anticoagulants, blood monitoring with platelet counts is important. After 3 weeks of therapy, monitoring is carried out at least once every 2 weeks. This way, a low platelet count can be diagnosed early.

Scheme No. 3. Antiplatelet agents (aspirin, dipyridamole, pentoxifylline)

Dipyridamole is one of the few drugs that can be used from early pregnancy. During treatment, blood monitoring is carried out once every 2 weeks while selecting therapy according to indications.

Combination acetylsalicylic acid with heparin is more effective than taking aspirin alone:

• if there was a case of spontaneous abortion without thrombosis, then low maintenance doses are used;
• when thrombosis is detected from early pregnancy, right from the moment of imaging ovum, heparin is prescribed together with aspirin, drugs with calcium and colecalciferol, which prevents the development of osteoporosis.

Scheme No. 4. Immunoglobulins

This scheme is not practiced everywhere. It consists of prescribing immunoglobulins in addition to anticoagulants and antiplatelet agents. If preeclampsia was previously detected, then immunoglobulins are used for 5 days every month. high dosages intravenously.

Scheme No. 5. Plasmapheresis (“purification” of blood)

Plasmapheresis is carried out strictly according to indications:

• high activity of the autoimmune process;
• hypercoagulation (increased blood clotting), which does not respond to drug therapy;
• allergic reaction to drugs;
• exacerbation of diseases from gastrointestinal tract(gastritis, peptic ulcer stomach and 12-p.k.).

Scheme No. 6. Surgical treatment

Performed for thrombosis both during pregnancy and in the postpartum period. Necessity surgical intervention determined together with the vascular surgeon.

Vladlena Razmeritsa, obstetrician-gynecologist, especially for the site

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