β2GPI Titre and its Clinical Correlation with Laboratory Antiphospholipid Antibodies Syndrome Presented by Fetal Loss
Rasha Mostafa Mohamed Mohie Eldine;
Abstract
Antiphospholipid syndrome is a systemic autoimmune disease associated with thrombosis and recurrent fetal loss with detectable antiphospholipid (APL) antibodies. The major antigenic target has been identifed as β2-glycoprotein I (β2GPI), which mediates binding of APL antibodies to target cells including endothelial cells, monocytes, platelets and trophoblasts, leading to prothrombotic and proinflammatory changes that ultimately result in thrombosis and fetal loss.
The actual cause of APS is unknown, but thought to be multifactorial. APS can involve almost any organ.
Diagnosis of APS is quite challenging. The Clinical and serological classification criteria for APS were first formulated and published in 1999 and called the Sapporo criteria. These criteria performed poorly due to many reasons among which there was no clear cut offs for the medium or high titre of ACL & the issue of difference in timing of laboratory testing in relation to the clinical event was not clarified adequately.
The need for new criteria led to Sydney 2006 where a panel of experts met at a workshop held during the international congress of International Society of Thrombosis and Hemostasis (ISTH) and set their recommendations; where clear cut offs for ACL were defined, β2GPI was included, the timing of laboratory testing with respect to the clinical thrombotic/obstetric event has been better defined along with other recommendations.
Despite of the great help these recommendations did, there were still limitations in the diagnosis of APS such as that there was no international consensus on laboratory testing and cut off values for ACL antibodies & anti-β2GP1.
The year 2009 came along with the new update for LA testing & strict guidelines. In which, LA coagulation testing should be done through 3 step procedure; screening, mixing experiment, confirmatory testing. Both APTT-LA and dRVVT tests should be performed together. It was not till 2014 where the guidelines for solid phase assays were published. Both guidelines should be adopted by all laboratories.
Therapy of the APS generally involves anticoagulation and antiplatelet drugs. Corticosteroids, and plasma exchange or IVIG should be given for patients with CAPS. .
The actual cause of APS is unknown, but thought to be multifactorial. APS can involve almost any organ.
Diagnosis of APS is quite challenging. The Clinical and serological classification criteria for APS were first formulated and published in 1999 and called the Sapporo criteria. These criteria performed poorly due to many reasons among which there was no clear cut offs for the medium or high titre of ACL & the issue of difference in timing of laboratory testing in relation to the clinical event was not clarified adequately.
The need for new criteria led to Sydney 2006 where a panel of experts met at a workshop held during the international congress of International Society of Thrombosis and Hemostasis (ISTH) and set their recommendations; where clear cut offs for ACL were defined, β2GPI was included, the timing of laboratory testing with respect to the clinical thrombotic/obstetric event has been better defined along with other recommendations.
Despite of the great help these recommendations did, there were still limitations in the diagnosis of APS such as that there was no international consensus on laboratory testing and cut off values for ACL antibodies & anti-β2GP1.
The year 2009 came along with the new update for LA testing & strict guidelines. In which, LA coagulation testing should be done through 3 step procedure; screening, mixing experiment, confirmatory testing. Both APTT-LA and dRVVT tests should be performed together. It was not till 2014 where the guidelines for solid phase assays were published. Both guidelines should be adopted by all laboratories.
Therapy of the APS generally involves anticoagulation and antiplatelet drugs. Corticosteroids, and plasma exchange or IVIG should be given for patients with CAPS. .
Other data
| Title | β2GPI Titre and its Clinical Correlation with Laboratory Antiphospholipid Antibodies Syndrome Presented by Fetal Loss | Other Titles | تيتر β2GPI وعلاقته الاكلينيكية بتحاليل مرض الاجسام المضادة للانتيفوسفوليبيد المتمثل فى فقد الجنين | Authors | Rasha Mostafa Mohamed Mohie Eldine | Issue Date | 2014 |
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