Korean J Intern Med.  2011 Dec;26(4):449-454. 10.3904/kjim.2011.26.4.449.

Clinical Implications of Elevated Antiphospholipid Antibodies in Adult Patients with Primary Immune Thrombocytopenia

• Yang YJ
• Yun GW
• Song IC
• Baek SW
• Lee KS
• Ryu HW
• Lee MW
• Lee HJ
• Yun HJ
• Kim S
• Jo DY

• KMID: 1729248
• DOI: http://doi.org/10.3904/kjim.2011.26.4.449

Abstract

BACKGROUND/AIMS
Antiphospholipid antibodies (aPL) have been detected in various proportions of patients with primary immune thrombocytopenia (ITP), but the clinical significance of this is debatable. The present study aimed to determine the frequency and clinical implications of elevated aPL in adult patients with ITP.
METHODS
We prospectively studied newly diagnosed adult patients with ITP who were enrolled between January 2003 and December 2008 at Chungnam National University Hospital. They were evaluated for the presence of lupus anticoagulant (LA) and anticardiolipin antibodies (aCL) at diagnosis and were followed for the development of thrombosis.
RESULTS
Seventy consecutive patients with ITP (median age, 48 years; range, 18 to 79) were enrolled. Twenty patients (28.5%) were positive for aPL at the time of diagnosis: aCL alone in 15 (75%), aCL and LA in two (10%), and LA alone in three (15%). Patients who had platelet counts < 50,000/microL were administered oral prednisolone with or without intravenous immune globulin. No difference was found between the aPL-positive and -negative groups regarding gender, initial platelet count, and response to the therapy. After a median follow-up of 20 months (range, 2 to 68), two of 20 patients who were aPL-positive (10%) developed thrombosis, whereas no thrombotic event was found among those who were aPL-negative.
CONCLUSIONS
Our data suggest that aPL levels should be determined at the initial presentation of ITP and that patients found to be aPL-positive should receive closer follow-up for thrombotic events.

Keyword

Antibodies, anticardiolipin; Antiphospholipid syndrome; Purpura, thrombocytopenic, idiopathic; Lupus coagulation inhibitor; Thrombosis

MeSH Terms

Adolescent
Adult
Aged
Antibodies, Anticardiolipin/*blood
Antibodies, Antiphospholipid/blood
Chi-Square Distribution
Female
Glucocorticoids/therapeutic use
Humans
Lupus Coagulation Inhibitor/*blood
Male
Middle Aged
Prednisolone/therapeutic use
Prospective Studies
Purpura, Thrombocytopenic, Idiopathic/*blood/drug therapy
Thrombocythemia, Essential/*blood/drug therapy
Thrombosis
Young Adult