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Detection of antiphospholipid antibodies in children and adolescents
C Kratz1, C Mauz-Körholz, H Kruck
1Department of Pediatric Hematology and Oncology, Heinrich-Heine-University Medical Center, Düsseldorf, Germany.
Insights
Antiphospholipid antibodies (APAs) are more common in children with various diseases than in healthy children. Increased APA levels in pediatric patients rarely cause bleeding or thrombosis.
Area of Science:
- Pediatric immunology
- Autoimmunity
- Clinical diagnostics
Background:
- Antiphospholipid antibodies (APAs) are associated with autoimmune diseases.
- Prevalence of APAs in pediatric populations with diverse conditions remains understudied.
Purpose of the Study:
- To investigate the prevalence of APAs in children and adolescents across various disease categories.
- To compare APA prevalence between different patient groups and healthy controls.
Main Methods:
- Enzyme-linked immunosorbent assay (ELISA) was used to detect IgG and IgM antibodies against cardiolipin, phosphatidylserine, and phosphatidic acid.
- Plasma samples from 203 children and adolescents (0.1–21 years) were analyzed.
- Patients were categorized into five groups: autoimmune diseases, infections, metabolic diseases, other diseases, and healthy controls.
Main Results:
- APAs were detected in 65 out of 203 pediatric patients (32%).
- APA prevalence was significantly higher in all patient groups compared to healthy children.
- The highest prevalence was observed in patients with autoimmune or infectious diseases.
- Thrombosis was not observed in any child with elevated APAs; bleeding occurred in 4 patients, with 3 having co-existing coagulation abnormalities.
Conclusions:
- Elevated antiphospholipid antibody titers are found in a variety of pediatric diseases.
- APA-associated clinical manifestations like thrombosis and bleeding are infrequent in the studied pediatric cohort.
- Further research is warranted to understand the clinical significance of APAs in pediatric conditions.
Abstract:
The prevalence of antiphospholipid antibodies (APAs) has not yet been studied in children and adolescents with various diseases. We assayed plasma samples of 203 children and adolescents, aged 0.1 to 21 years (median 6 years), by enzyme-linked immunosorbent assay detecting immunoglobulin G (IgG) and IgM antibodies directed against cardiolipin, phosphatidylserine, and phosphatidic acid. According to their diagnosis children were divided into five groups: 10 patients with autoimmune and autoimmune-like diseases (group I); 88 patients with infections (group II); 20 patients with metabolic diseases (group III); 65 children with various other diseases (group IV); 20 healthy children without physical illnes (group V). Results were compared for statistical significance using Fisher's exact test. APAs were found in 65 of 203 patients. In all groups of patients the prevalence of APAs was increased compared with healthy children. The highest prevalence of APAs was found in patients with autoimmune or autoimmune-like diseases or infections. Thrombosis did not occur in children with increased APA levels. In 4 of 65 patients with detectable APAs bleeding was observed. However, three of these four children had additional coagulation abnormalities. We conclude that in children and adolescents increased APA titers may occur in a variety of diseases. The frequency of APA-related symptoms is low.
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