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Antiphospholipid antibodies in children without and in adults with and without thrombophilia
H J Siemens1, S Gutsche, S Brückner
1Department of Internal Medicine II, Lübeck, Germany. siemens@medinf.mu-luebeck.de
Insights
Children show a higher prevalence of lupus anticoagulants (LA) but lower levels of anticardiolipin antibodies (ACA) compared to adults. These findings are crucial for evaluating pediatric thromboembolic diseases.
Area of Science:
- Hematology
- Pediatric Thrombosis
- Immunology
Background:
- Antiphospholipid antibodies (APAs) are established risk factors for thromboembolic diseases in adults.
- Limited data exists on APA prevalence and significance in pediatric populations.
Purpose of the Study:
- To analyze the prevalence of various antiphospholipid antibodies (APAs) in children without thromboembolic complications.
- To compare APA findings in children with adult cohorts, including those with and without thromboembolic events.
Main Methods:
- Evaluated 202 children and two adult groups (200 post-DVT, 200 controls) for APAs.
- Assessed four lupus anticoagulant (LA) screening tests and three ELISA assays for anticardiolipin antibodies (ACA), anti-beta2-glycoprotein I, and anti-phosphatidyl-serine.
Main Results:
- Children exhibited a significantly higher prevalence of LA compared to adults.
- Children showed lower ACA values than adults with a history of thromboembolism.
- APA findings in children resembled those in the normal adult control group.
Conclusions:
- Pediatric APA profiles differ from adult profiles, particularly regarding LA and ACA.
- These differences necessitate careful consideration when diagnosing and managing thromboembolic diseases in children.
Abstract:
Antiphospholipid antibodies (APAs) are considered risk factors in patients with thromboembolic diseases. Although the incidence of such acquired coagulation disturbances in adults are well described, only few data exist for children. Therefore, in a first step to collect new data we analyzed the presence of different APAs in 202 consecutive children and compared them with two groups of adults. The children screened for APA were exclusively those who did not have any thromboembolic complications or a tendency for thrombophilia due to other underlying diseases such as systemic lupus or malignancy in their past or present medical history. Consecutive blood samples were evaluated from routine laboratory specimens. The two groups of adults comprised 200 patients after deep vein thrombosis and 200 patients without thromboembolic events that served as controls. Four lupus anticoagulant (LA) screening tests were determined: the dilute Russell's viper venom test; a lupus anticoagulant-sensitive activated partial thromboplastin time reagent; a second lupus-sensitive activated partial thromboplastin time; and the Kaolin clotting time. Furthermore, three different antiphospholipid antibodies ELISA assays against cardiolipin (ACA), beta2-glycoprotein I, and phosphatidyl-serine, were determined. The children had a much higher prevalence for LA than did the adults. On the other hand, their values for ACA were significantly lower than in adults with a history of thromboembolism. Findings in children were similar to the normal adult group. This has to be taken into account when evaluating children with thromboembolic diseases.