Abstract Number: PB1908
Meeting: ISTH 2020 Congress
Theme: Thrombotic Microangiopathies » Antiphospholipid Syndrome
Background: About a hundred cases of lupus anticoagulant-hypothrombinemia syndrome have been reported. More common in children and women with systemic lupus erythematosus; sometimes no underlying condition is found.
Aims: Report of a case of infrequent Lupus Anticoagulant syndrome.
Methods: Clinical data available in the medical reports and laboratory findings are revised.
Results: We report a case of a female patient of 72 years referred to a haematology consult with prolonged prothrombin clot timing since May 2016. The patient was asymptomatic and the consult was previous to a knee prosthesis surgery. Previous medical conditions were two normal pregnancies, localized breast cancer with adjuvant hormonal therapy with letrozole, dyslipidemia, chronic venous insufficiency and hypertension. No previous haemorrhagic or thrombotic events were reported.
Laboratory test performed shows a normal activity for clotting factor VII. Immediate and incubated mixing study indicated the presence of an inhibitor. Russell anticoagulant was strongly positive with no interferences documented and anticardiolipin and beta-2-glycoprotein antibodies were both positive.
| PT ratio | 1.4 (0.8-1.2) |
| PT mixing study | 14.9 seconds, ratio 1.4; (after one hour incubation: 14.7 seconds, ratio 1.37) |
| aTTP | 34 s (24-38) |
| aTTP ratio | 1.1 (0.8-1.2) |
| Russell | 2.54 (>1.20 positive) |
| Silica | 1.16 (>1.20 positive) |
| Factor II | 60% (70-130) |
| Factor x | 67% (70-130) |
| Anticardiolipin antibody (IgM) | Positive |
| Anti β2 GPI antibody (IgM) | Positive |
[Table 1. Laboratory findings]
Reducing the thrombotic risk after the surgery and referral to a rheumatologist was recommended to the patient. No rheumatologic condition was diagnosed and the surgery performed in December of 2019 had no immediate complications. The patient was discharged after three days of hospitalization, with daily prophylactic enoxaparin 60 mg.
Conclusions: Lupus anticoagulant is associated with thrombotic events but some cases of bleeding have been reported in LAHS. There is no specific treatment other than treating the underlying condition and supportive care in case of bleeding.
Our patient had several risk factors for thrombosis: hypertension, dyslipidemia, hormonal therapy with letrozole, chronic venous insufficiency and knee surgery. Prophylaxis with enoxaparin 60 mg once a day was effective to prevent thrombotic events with no reported bleeding events other than minimum haematoma in the operated knee which is common after surgery.
To cite this abstract in AMA style:
Mayani K, Machado Machado P, Raya Sánchez JM, Pardina Echevarría M, Lacalzada Higueras C, Pérez Pinilla B, Hernández García MT. Lupus Anticoagulant-Hypothrombinemia Syndrome (LAHS): A Case Report [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/lupus-anticoagulant-hypothrombinemia-syndrome-lahs-a-case-report/. Accessed October 1, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/lupus-anticoagulant-hypothrombinemia-syndrome-lahs-a-case-report/