What is A woman with Hio recurrent aboions presents with isolated increase in APTT is: and explain in detail?
Ans. is a i.e. Lupus anticoagulant Anti Russel Viper Venom Antibody is the diagnostic test for antiphospholipid antibody syndrome, which is an impoant cause of recurrent aboion. Friends, Antiphospholipid antibody syndrome (APS) is an impoant and emerging topic for PGME exams. It is one of the least touched topic at undergraduate level. Therefore, I am explaining it in detail. Do go through it : Antiphospholipid antibody syndrome : It is a treatable, autoimune disorder associated with recurrent second trimester pregnancy loss.deg Antiphospholipid antibodies are acquired antibodies targeted against a phospholipid. They can be IgM, IgG or IgA isotopes. Most impoant antiphospholipid antibodies are : Lupus anticoagulant (LAC) -- It was named so because it was first found in patients with SLE & prolonged paial thromboplastin time -- But the name is a misomer as though it increases PTT (i.e., similar to anticoagulant) but functions as a procoagulant & causes thrombosis Anticardiolipin antibody - It is most commonly seen in patients with repetitive early pregnancy loss BFP - ST i.e. antibody which causes biologically false positive syphilis test -- Less common antiphospholipid antibody - Both anticardio lipin & BFPST antibodies measure the antibody against cardiotipin but they are not same. Diagnosis For diagnosis of antiphospholipid antibody syndrome there should be two positive tests 6 weeks apa for lupus anticoagulant or anticardiolipin antibody. Mqrpclerrient 7 Treatment as proposed by ACOG is a combination of low dose aspirin (81 mg) daily and low molecular weight heparin (LMWH) in prophylactic doses (e.g. dalteparin 5000 units S/C twice daily), staed as soon as pregnancy is confirmed. Aspirin can be initiated preconceptionaly and is usually discontinued at 36 weeks. LMWH is continued up to term and for 5 days postpaum. Women with previous history of thrombosis will usually already be on maintenance therapy with warfarin. In such cases as soon as pregnancy is confirmed, warfarin is changed to LMWH and aspirin. Although this treatment improves overall pregnancy success, these women remain at high risk for preterm labor, PROM. IUGR. preeclampsia and placental abruption. In question 10 Patient is presenting with recurrent aboions with isolated increase in APTT which leaves no doubt that lupus anticoagulant is the cause.