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Michelle Petri - One of the best experts on this subject based on the ideXlab platform.
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evaluation of different ways to identify persistent positivity of Lupus Anticoagulant in systemic Lupus erythematosus
Lupus science & medicine, 2020Co-Authors: Michelle Petri, Mertcan Avci, Laurence S MagderAbstract:OBJECTIVE Persistent positivity for Lupus Anticoagulant has been associated with an increased risk of thrombosis among patients with SLE. Persistent positivity is often defined as having two positive assessments separated by more than 90 days. Our objective was to determine whether frequent repeated Lupus Anticoagulant testing would identify more patients with persistent positivity, and whether the additional patients identified were still at increased risk of thrombosis. METHODS Using a large longitudinal cohort with frequent Lupus Anticoagulant testing, we compared three different hypothetical clinical strategies for identifying persistent positivity: (1) assessment of Lupus Anticoagulant twice more than 90 days apart; (2) assessment of Lupus Anticoagulant annually, with repeat testing if an annual assessment was positive; and (3) assessment of Lupus Anticoagulant 16 times (approximately quarterly for 4 years). The prevalence of persistent positivity was compared between the approaches and by demographic subgroups. Subgroups based on these definitions were compared with respect to the risk of thrombosis in subsequent follow-up using discrete survival analysis. RESULTS Among the 785 patients included in our analysis, the prevalence of persistent Lupus Anticoagulant as defined by the first two patient assessments was 4.3%. Annual assessment resulted in a prevalence of 6.6%, and using all 16 assessments resulted in a prevalence of 10.5%. The prevalence was substantially higher in men than in women, and in Caucasians than in African-Americans (p<0.01 for all comparisons). The rate of thrombosis was significantly elevated among those with persistently positive Lupus Anticoagulant by any definition (HR ranging from 2.75 to 3.42) relative to those without persistently positive Lupus Anticoagulant. CONCLUSION While there are other risk factors for thrombosis (including other antiphospholipid subtypes), more frequent testing (not limited to twice over 3 months) for Lupus Anticoagulant would be useful for identifying more patients with SLE at elevated risk for thrombosis.
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the frequency of Lupus Anticoagulant in systemic Lupus erythematosus
Annals of Internal Medicine, 2020Co-Authors: Michelle Petri, Margaret Rheinschmidt, Quinn Whitingokeefe, David B Hellmann, Laurence CorashAbstract:Abstract Recent reviews have suggested a higher frequency of the Lupus Anticoagulant or related antiphospholipid antibodies in patients with systemic Lupus erythematosus (21% to 65%) than was found...
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Lupus Anticoagulant disease activity and low complement in the first trimester are predictive of pregnancy loss
Lupus science & medicine, 2015Co-Authors: Anil Mankee, Michelle Petri, Laurence S MagderAbstract:Introduction Multiple factors, including proteinuria, antiphospholipid syndrome, thrombocytopenia and hypertension, are predictive of pregnancy loss in systemic Lupus erythematosus (SLE). In the PROMISSE study of predictors of pregnancy loss, only a battery of Lupus Anticoagulant tests was predictive of a composite of adverse pregnancy outcomes. We examined the predictive value of one baseline Lupus Anticoagulant test (dilute Russell viper venom time) with pregnancy loss in women with SLE. Methods From the Hopkins Lupus Cohort, there were 202 pregnancies from 175 different women after excluding twin pregnancies and pregnancies for which we did not have a first trimester assessment of Lupus Anticoagulant. We determined the percentage of women who had a pregnancy loss in groups defined by potential risk factors. The Lupus Anticoagulant was determined by dilute Russell viper venom time with appropriate mixing and confirmatory testing. Generalised estimating equations were used to calculate p values, accounting for repeated pregnancies in the same woman. Results The age at pregnancy was 40 (3%). 55% were Caucasian and 34% African-American. Among those with Lupus Anticoagulant during the first trimester, 6/16 (38%) experienced a pregnancy loss compared with only 16/186 (9%) of other pregnancies (p=0.003). In addition, those with low complement or higher disease activity had a higher rate of pregnancy loss than those without (p=0.049 and 0.005, respectively). In contrast, there was no association between elevated anticardiolipin in the first trimester and pregnancy loss. Conclusions The strongest predictor of pregnancy loss in SLE in the first trimester is the Lupus Anticoagulant. In addition, moderate disease activity by the physician global assessment and low complement measured in the first trimester were predictive of pregnancy loss. These data suggest that treatment of the Lupus Anticoagulant could be considered, even in the absence of history of pregnancy loss.
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The automated modified Russell viper venom time test for the Lupus Anticoagulant.
The Journal of rheumatology, 1991Co-Authors: Michelle Petri, L Nelson, F Weimer, D Anderson, T Darlington, L CorashAbstract:Antiphospholipid antibodies, both anticardiolipin antibody and Lupus Anticoagulant, are associated with a hypercoagulable state, manifested as thrombotic events and pregnancy losses. Multiple coagulation tests are available for the Lupus Anticoagulant, but few are in wide use. The modified Russell viper venom test (RVVT) is one of several excellent tests for the Lupus Anticoagulant, with high sensitivity and specificity. We present an automated method for measuring the RVVT and demonstrate its reproducibility.
Laurence S Magder - One of the best experts on this subject based on the ideXlab platform.
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evaluation of different ways to identify persistent positivity of Lupus Anticoagulant in systemic Lupus erythematosus
Lupus science & medicine, 2020Co-Authors: Michelle Petri, Mertcan Avci, Laurence S MagderAbstract:OBJECTIVE Persistent positivity for Lupus Anticoagulant has been associated with an increased risk of thrombosis among patients with SLE. Persistent positivity is often defined as having two positive assessments separated by more than 90 days. Our objective was to determine whether frequent repeated Lupus Anticoagulant testing would identify more patients with persistent positivity, and whether the additional patients identified were still at increased risk of thrombosis. METHODS Using a large longitudinal cohort with frequent Lupus Anticoagulant testing, we compared three different hypothetical clinical strategies for identifying persistent positivity: (1) assessment of Lupus Anticoagulant twice more than 90 days apart; (2) assessment of Lupus Anticoagulant annually, with repeat testing if an annual assessment was positive; and (3) assessment of Lupus Anticoagulant 16 times (approximately quarterly for 4 years). The prevalence of persistent positivity was compared between the approaches and by demographic subgroups. Subgroups based on these definitions were compared with respect to the risk of thrombosis in subsequent follow-up using discrete survival analysis. RESULTS Among the 785 patients included in our analysis, the prevalence of persistent Lupus Anticoagulant as defined by the first two patient assessments was 4.3%. Annual assessment resulted in a prevalence of 6.6%, and using all 16 assessments resulted in a prevalence of 10.5%. The prevalence was substantially higher in men than in women, and in Caucasians than in African-Americans (p<0.01 for all comparisons). The rate of thrombosis was significantly elevated among those with persistently positive Lupus Anticoagulant by any definition (HR ranging from 2.75 to 3.42) relative to those without persistently positive Lupus Anticoagulant. CONCLUSION While there are other risk factors for thrombosis (including other antiphospholipid subtypes), more frequent testing (not limited to twice over 3 months) for Lupus Anticoagulant would be useful for identifying more patients with SLE at elevated risk for thrombosis.
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Lupus Anticoagulant disease activity and low complement in the first trimester are predictive of pregnancy loss
Lupus science & medicine, 2015Co-Authors: Anil Mankee, Michelle Petri, Laurence S MagderAbstract:Introduction Multiple factors, including proteinuria, antiphospholipid syndrome, thrombocytopenia and hypertension, are predictive of pregnancy loss in systemic Lupus erythematosus (SLE). In the PROMISSE study of predictors of pregnancy loss, only a battery of Lupus Anticoagulant tests was predictive of a composite of adverse pregnancy outcomes. We examined the predictive value of one baseline Lupus Anticoagulant test (dilute Russell viper venom time) with pregnancy loss in women with SLE. Methods From the Hopkins Lupus Cohort, there were 202 pregnancies from 175 different women after excluding twin pregnancies and pregnancies for which we did not have a first trimester assessment of Lupus Anticoagulant. We determined the percentage of women who had a pregnancy loss in groups defined by potential risk factors. The Lupus Anticoagulant was determined by dilute Russell viper venom time with appropriate mixing and confirmatory testing. Generalised estimating equations were used to calculate p values, accounting for repeated pregnancies in the same woman. Results The age at pregnancy was 40 (3%). 55% were Caucasian and 34% African-American. Among those with Lupus Anticoagulant during the first trimester, 6/16 (38%) experienced a pregnancy loss compared with only 16/186 (9%) of other pregnancies (p=0.003). In addition, those with low complement or higher disease activity had a higher rate of pregnancy loss than those without (p=0.049 and 0.005, respectively). In contrast, there was no association between elevated anticardiolipin in the first trimester and pregnancy loss. Conclusions The strongest predictor of pregnancy loss in SLE in the first trimester is the Lupus Anticoagulant. In addition, moderate disease activity by the physician global assessment and low complement measured in the first trimester were predictive of pregnancy loss. These data suggest that treatment of the Lupus Anticoagulant could be considered, even in the absence of history of pregnancy loss.
James L. Zehnder - One of the best experts on this subject based on the ideXlab platform.
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prozone effect in the diagnosis of Lupus Anticoagulant for the Lupus Anticoagulant hypoprothrombinemia syndrome
American Journal of Clinical Pathology, 2016Co-Authors: Jing Jin, James L. ZehnderAbstract:Objectives: The main clinical sequela of a Lupus Anticoagulant is increased thrombosis risk. However, bleeding due to Lupus Anticoagulant-hypoprothrombinemia syndrome is a rare but well-described manifestation of antiphospholipid syndrome. The association of acute acquired hypoprothrombinemia is caused by a Lupus Anticoagulant’s specificity to prothrombin, which results in clearance of prothrombin and bleeding due to hypoprothrombinemia (usually <10% of normal). Severe life-threatening bleeding is most frequently reported in children with systemic Lupus erythematosus or in healthy children after viral infection. In such cases, steroid therapy is usually effective in controlling the bleeding problems and improving prothrombin levels. Methods: We report one pediatric patient with a Lupus Anticoagulant who had acute hemorrhagic diathesis. Results: The diagnosis in this case was complicated by the presence of a prozone effect in Lupus Anticoagulant testing. The prozone effect (also known as hook effect) refers to situations where very high concentrations of antibody mask detection, typically in antigen-antibody reactions, which depend on visualization of agglutination. Decreasing the antibody/antigen ratio results in detectable antigen-antibody complexes. Conclusions: We report for the first time a variation on this theme in a patient with a Lupus Anticoagulant-type antiphospholipid antibody and hypoprothrombinemia, which corrected with immunosuppression and restoration of normal prothrombin levels.
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Prozone Effect in the Diagnosis of Lupus Anticoagulant for the Lupus Anticoagulant-Hypoprothrombinemia Syndrome
American journal of clinical pathology, 2016Co-Authors: Jing Jin, James L. ZehnderAbstract:Objectives: The main clinical sequela of a Lupus Anticoagulant is increased thrombosis risk. However, bleeding due to Lupus Anticoagulant-hypoprothrombinemia syndrome is a rare but well-described manifestation of antiphospholipid syndrome. The association of acute acquired hypoprothrombinemia is caused by a Lupus Anticoagulant’s specificity to prothrombin, which results in clearance of prothrombin and bleeding due to hypoprothrombinemia (usually
Joy Ashcraft - One of the best experts on this subject based on the ideXlab platform.
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Hypoprothrombinemia and severe hemorrhage associated with a Lupus Anticoagulant
The Journal of pediatrics, 1993Co-Authors: Juan Carlos Bernini, George R. Buchanan, Joy AshcraftAbstract:We recently encountered a previously healthy 3-year-old girl who had severe bleeding resulting from a severe deficiency of prothrombin. A Lupus Anticoagulant was identified by several different methods. The patient was successfully treated with glucocorticoids. This rare complication of a Lupus Anticoagulant should be considered in the differential diagnosis of a previously well child who suddenly has hemorrhage.
Jing Jin - One of the best experts on this subject based on the ideXlab platform.
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prozone effect in the diagnosis of Lupus Anticoagulant for the Lupus Anticoagulant hypoprothrombinemia syndrome
American Journal of Clinical Pathology, 2016Co-Authors: Jing Jin, James L. ZehnderAbstract:Objectives: The main clinical sequela of a Lupus Anticoagulant is increased thrombosis risk. However, bleeding due to Lupus Anticoagulant-hypoprothrombinemia syndrome is a rare but well-described manifestation of antiphospholipid syndrome. The association of acute acquired hypoprothrombinemia is caused by a Lupus Anticoagulant’s specificity to prothrombin, which results in clearance of prothrombin and bleeding due to hypoprothrombinemia (usually <10% of normal). Severe life-threatening bleeding is most frequently reported in children with systemic Lupus erythematosus or in healthy children after viral infection. In such cases, steroid therapy is usually effective in controlling the bleeding problems and improving prothrombin levels. Methods: We report one pediatric patient with a Lupus Anticoagulant who had acute hemorrhagic diathesis. Results: The diagnosis in this case was complicated by the presence of a prozone effect in Lupus Anticoagulant testing. The prozone effect (also known as hook effect) refers to situations where very high concentrations of antibody mask detection, typically in antigen-antibody reactions, which depend on visualization of agglutination. Decreasing the antibody/antigen ratio results in detectable antigen-antibody complexes. Conclusions: We report for the first time a variation on this theme in a patient with a Lupus Anticoagulant-type antiphospholipid antibody and hypoprothrombinemia, which corrected with immunosuppression and restoration of normal prothrombin levels.
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Prozone Effect in the Diagnosis of Lupus Anticoagulant for the Lupus Anticoagulant-Hypoprothrombinemia Syndrome
American journal of clinical pathology, 2016Co-Authors: Jing Jin, James L. ZehnderAbstract:Objectives: The main clinical sequela of a Lupus Anticoagulant is increased thrombosis risk. However, bleeding due to Lupus Anticoagulant-hypoprothrombinemia syndrome is a rare but well-described manifestation of antiphospholipid syndrome. The association of acute acquired hypoprothrombinemia is caused by a Lupus Anticoagulant’s specificity to prothrombin, which results in clearance of prothrombin and bleeding due to hypoprothrombinemia (usually
