Prolonged aPTT after kidney transplantation due to transient lupus anticoagulants

Nybo, Mads; Dieperink, Hans; Kristensen, S R

doi:10.1093/ndt/gfk017

Cited by 3 publications

(4 citation statements)

References 14 publications

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“…well as absolute aPL titres (11,14,15,18,20,23,27). Where indicated and where possible we have shown cut-offs, average or median serum of aPL titres in Table 1B.…”

Section: Expression Of Antiphospholipid Antibody Positivitymentioning

confidence: 99%

“…Five articles evaluated the effect of renal transplant on aPL (17,18,20,22,24); in particular four investigated the de novo appearance of aPL or LA after renal transplant (17,20,22,24), two studies both aPL and LA ( 22,24) and three investigated the disappearance of aPL (18) and aPL and LA ( 22,24) after renal transplant. The four studies evaluating a de-novo appearance of post-transplant aPL comprised 464 recipients; the pooled prevalence of aPL increased from 19% pre-transplant to 39% post-allograft (p<0.04) with wide heterogeneity though all studies favoured an increase (Figure 4A).…”

Section: Comparison Of Antiphospholipid Antibody Pre and Post Allograftmentioning

confidence: 99%

“…With regards to the de novo appearance of aPL post allograft, sometimes for a short period (20), a surge in oxidative stress induced by the new kidney (36) over a given background (41) may represent an added stimulus to the rapid generation of auto-antibodies against oxidated lipids from (42) by auto-reactive memory B cells harbouring also aPL in their repertoire; among these, the IgM isotype represents a natural auto-antibodies with a protective role still able to behave as lupus anticoagulant (20) that may disappear, while others, clonally selected, may persist for a longer time (43).…”

Section: Accepted Manuscript 14mentioning

confidence: 99%

See 2 more Smart Citations

Antiphospholipid antibodies and renal transplant: A systematic review and meta-analysis

Merashli

Bucci

Gentile

et al. 2019

Seminars in Arthritis and Rheumatism

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Objective. To evaluate the effect of antiphospholipid antibodies (aPL) on renal allograft outcome after kidney transplantation. Methods. A systematic search of EMBASE and PubMed databases from inception to July 2018 was run according to PRISMA guidelines; Peto's odds ratio (OR) for rare events was used for the meta-analysis. Results. Our inclusion/exclusion criteria were met by 22 cohort studies having different outcomes: allograft thrombosis (n=9) and thromboprophylaxis (n=3), allograft loss from any cause (n=9), allograft malfunction (n=3), duration (n=2), glomerular filtration rate at 1 year (n=3) and allograft rejection (n=5). The pooled prevalence of allograft thrombosis and of thrombotic microangiopathy was greater in aPL+ve than negative recipients (10.4% vs 1.7%,

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“…well as absolute aPL titres (11,14,15,18,20,23,27). Where indicated and where possible we have shown cut-offs, average or median serum of aPL titres in Table 1B.…”

Section: Expression Of Antiphospholipid Antibody Positivitymentioning

confidence: 99%

Section: Comparison Of Antiphospholipid Antibody Pre and Post Allograftmentioning

confidence: 99%

Section: Accepted Manuscript 14mentioning

confidence: 99%

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Antiphospholipid antibodies and renal transplant: A systematic review and meta-analysis

Merashli

Bucci

Gentile

et al. 2019

Seminars in Arthritis and Rheumatism

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“…Presence of lupus anticoagulant (LA) was found to be the most common cause of isolated prolongation of aPTT in different populations of critically ill patients: acute care (53.1%) [ 20 ], and post kidney transplantation (68.4%) [ 21 ]. LA is associated with sepsis and/or catecholamine treatment, hence is frequently present in critically ill subjects.…”

Section: Differential Diagnosis Of Isolated Prolongation Of Activated...mentioning

confidence: 99%

Isolated prolongation of activated partial thromboplastin time in intensive care unit patients: a practical diagnostic algorithm and management options

Czempik¹,

Żurawska²,

Krzych³

2020

ait

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Abnormal values for standard laboratory tests of coagulation are frequently reported in critically ill patients. Standard laboratory tests of coagulation include activated partial thromboplastin time (aPTT), prothrombin time (PT), thrombin time (TT), fibrinogen concentration (Clauss method) and platelet count (PLT). Septic patients are frequently hospitalised in the intensive care unit (ICU) and may present with sepsis-associated coagulopathy, characterised by prolonged PT and low PLT, as well as disseminated intravascular coagulation, characterised by low PLT, elevated fibrin-related marker (soluble fibrin monomer, fibrin degradation product), prolonged PT and low fibrinogen [1]. Isolated prolongation of aPTT occurs less frequently in the ICU setting and has numerous causes. Preanalytical error should be considered in the context of isolated prolongation of aPTT in the ICU setting. It is important to mention that aPTT suffers from more interferences than PT. Factors such as reagent or activator used may have an impact here; therefore clinical laboratories should establish local reference values for aPTT [2]. Apart from preanalytical error, acquired and congenital causes may lead to isolated

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Interference from lupus anticoagulant on von Willebrand factor measurement in splenic marginal zone lymphoma

Vinholt

Nybo

2015

Blood Coagulation &Amp; Fibrinolysis

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We present a case concerning a patient with splenic marginal zone lymphoma (SMZL) and isolated prolonged activated partial thromboplastin time (aPTT) caused by lupus anticoagulant. Von Willebrand factor (VWF) activity and antigen were immeasurable by latex particle immunoturbidimetric assays, and several coagulation factor levels were decreased. However, VWF activity and antigen were normal when analyzed by other methods. Also, coagulation factor levels were normal if an aPTT reagent with low lupus anticoagulant sensitivity or a chromogenic method was applied. Altogether, the initial findings were because of lupus anticoagulant interference and in fact, the patient had normal VWF activity and coagulation status. Interference of lupus anticoagulant in clot-based assays is well known but has not previously been described in VWF assays. This is furthermore the first report in which lupus anticoagulant activity in SMZL cannot be ascribed to a monoclonal immunoglobulin. In our study, aPTT normalized after treatment, suggesting resolution of lupus anticoagulant. APTT could thus be a marker of treatment response in SMZL. Whether treatment decreases the thrombosis risk due to lupus anticoagulant remains unknown.

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Prolonged aPTT after kidney transplantation due to transient lupus anticoagulants

Cited by 3 publications

References 14 publications

Antiphospholipid antibodies and renal transplant: A systematic review and meta-analysis

Antiphospholipid antibodies and renal transplant: A systematic review and meta-analysis

Isolated prolongation of activated partial thromboplastin time in intensive care unit patients: a practical diagnostic algorithm and management options

Interference from lupus anticoagulant on von Willebrand factor measurement in splenic marginal zone lymphoma

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