PB0967 - Characteristics of patients at a tertiary hospital in Johannesburg South Africa with a Lupus anticoagulant: Are we following the guidelines?

Background: Lupus anticoagulants (LAs) may be associated with pathogenic thrombosis and adverse obstetric outcomes. LAs are detected with a dilute Russel viper venom test (DRVVT) and Lupus-sensitive partial thromboplastin time. LAs with detectable antiphospholipid antibodies (aPLa), anti-Cardiolipin and anti-Beta-2 Glycoprotein, in the correct clinical scenario are pathognomonic of antiphospholipid syndrome (APS). The underlying pathogenesis of APS is unclear but it is commoner with connective tissue disorders like systemic lupus erythematosus (SLE) and possibly Human immunodeficiency virus (HIV) infection – both common in South Africa.

Aims: Review positive DRVVT tests retrospectively to establish patient demographics, accompanying aPLa tests, appropriate repeat testing and the presence of potential contributory factors. Ethics approval was obtained from the University of Witwatersrand (M231174).

Methods: Retrospective assessment of the demographics and laboratory testing of patients with a LA over 6-months in a tertiary hospital in South Africa.

Results: 69 patients tested LA positive over the review period. These patients were predominantly female (90%) with a median age of 33 years and most LA tests were requested by antenatal clinics. Only 11 (15%) of these positive tests were appropriately repeated and < 70% of patients had an accompanying aPLa test. 10 (14%) patients were HIV-infected and 15 (22%) patients had antinuclear antibodies although the pattern of positivity varied. Interestingly, 2 patients had HIV infection with strong antinuclear antibodies.

Conclusion(s): APS is a serious condition and accurate diagnosis ensures appropriate management including lifelong anticoagulation for patients with proven thromboses and aspirin and heparin to prevent recurrent fetal loss. Most positive LA tests in this study were not repeated as recommended and aPLa testing was done sporadically. The majority of LA tests were requested for young women accessing antenatal care and the incomplete testing may impact patient outcomes. Better adherence to guidelines for APS testing will improve standardisation and patient outcomes.