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Anti-prothrombin antibodies and the lupus anticoagulant
RA Fleck, SI Rapaport and LV Rao
Department of Pathology, University of California School of Medicine, San
Diego.
The investigators have evaluated the frequency and manifestations of
anti-prothrombin antibodies in patients with the lupus anticoagulant.
Thirty-one of 42 patients with lupus anticoagulants associated with a
variety of underlying conditions (74%) had evidence on crossed
immunoelectrophoresis of anti-prothrombin antibodies. Twenty-four of 25
patients with an activated partial thromboplastin time exceeding 50 seconds
and 14 of 15 patients with a prothrombin time exceeding control by more
than two seconds had demonstrable anti-prothrombin antibodies. Three of the
31 patients with anti-prothrombin antibodies had essentially no measurable
plasma prothrombin, a presumed result of accelerated clearance of
prothrombin/prothrombin antibody complexes. Each of these patients had bled
abnormally. The remaining patients with anti-prothrombin antibodies had
neither substantial hypoprothrombinemia nor hemorrhagic manifestations,
which confirms the non-neutralizing property of anti-prothrombin antibodies
associated with the lupus anticoagulant. Since lupus anticoagulant
immunoglobulins are known to react with phospholipids, the high prevalence
of antibodies binding prothrombin led us to test the hypothesis of antibody
polyreactivity. Adsorption of three lupus anticoagulant plasmas with
insolubilized prothrombin markedly diminished evidence of both
prothrombin/prothrombin antibody complexes and anticoagulant activity.
Eluates of the insolubilized prothrombin contained IgG that not only bound
prothrombin but possessed lupus anticoagulant activity.
Volume 72,
Issue 2,
pp. 512-519,
08/01/1988
Copyright © 1988 by The American Society of Hematology
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