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Accidental detection of lupus anticoagulants in children
P Venugopalan1, R Bushra, D Gravell
1Departments of Child Health and Haematology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman. gopalax@omantel.net.om
Insights
Lupus anticoagulants in children, often following infections, are usually harmless and resolve on their own. While rare, monitoring is advised due to potential risks like bleeding or thrombosis.
Area of Science:
- Pediatric Hematology
- Autoimmune Disorders
- Clinical Diagnostics
Background:
- Routine pre-operative evaluations can reveal unexpected hematological findings.
- Prolonged activated partial thromboplastin time (aPTT) necessitates further investigation.
- Lupus anticoagulants (LAs) are antiphospholipid antibodies that can affect coagulation tests.
Observation:
- Two pediatric patients, a 6-month-old infant and an 11-year-old girl, presented with prolonged aPTT and positive lupus anticoagulants during pre-operative assessment.
- Both children successfully underwent cardiac surgery without immediate thrombotic or bleeding complications.
Findings:
- Literature review indicates that positive lupus anticoagulants in children frequently follow minor infections and are typically benign and self-limiting.
- A small subset of children with positive lupus anticoagulants may develop future complications, including bleeding, thrombosis, or autoimmune disorders.
Implications:
- These findings suggest that transient lupus anticoagulants in pediatric patients, especially post-infection, may not require intervention if asymptomatic.
- Careful monitoring is warranted for a minority of children who may develop significant clinical sequelae.
- This highlights the importance of understanding the natural history and potential risks associated with lupus anticoagulants in pediatric populations.
Abstract:
During routine pre-operative evaluation, a 6-month-old infant and an 11-year-old girl were found to have prolonged activated partial thromboplastin time with positive lupus anticoagulants. Both children underwent successful cardiac surgery and had no thrombotic or bleeding complications. A literature search revealed that positive lupus anticoagulants can follow minor infections in otherwise asymptomatic children and are benign and self-limiting. A minority, however, can develop bleeding, thrombosis or an auto-immune disorder.