R. A. Asherson

Thrombocytopenia in SLE and related autoimmune disorders: association with anticardiolipin antibody

Anticardiolipin antibody levels were determined in 116 patients with systemic lupus erythematosus and related autoimmune disorders. Forty‐three of these patients had a history of thrombocytopenia—36 of whom had SLE, three primary Sjögrens syndrome, two rheumatoid arthritis and two mixed connective tissue disease. IgG anticardiolipin antibody levels were raised in 31 (72%) of the 43 patients and IgM anticardiolipin antibody levels were raised in 19 (44%). There was a strong statistical correlation between thrombocytopenia and raised anticardiolipin antibody levels of both the IgG (P < 0.001) and IgM (P < 0.01) immunoglobulin classes. Of the 20 patients with the highest IgG anticardiolipin antibody levels 16 had a history of thrombocytopenia. We suggest that anticardiolipin antibodies may play a direct role in mediating platelet destruction in autoimmune disorders.

Anticardiolipin antibodies in autoimmune thrombocytopenic purpura

Using a recently devised solid phase radioimmunoassay to detect anticardiolipin antibodies, we report the presence of these antibodies in 30 of 96 patients with chronic autoimmune thrombocytopenic purpura (AITP). IgG anticardiolipin antibody levels were elevated in 14 patients and IgM anticardiolipin antibody levels were elevated in 27 patients.

Arterial occlusion causing large bowel infarction--a reflection of clotting diathesis in SLE.

SummaryThe patient, a 44-year old woman with systemic lupus erythematosus, (SLE), developed infarction of the bowel and spleen after occlusion of the inferior mesenteric and splenic arteries, necessitating colectomy and splenectomy. She had had previous cerebral thromboses and a lower limb deep vein thrombosis. Histological examination of the involved vessels showed the presence of thrombus only with the total absence of any vasculitis. The patient demonstrated antibodies to phospholipid — the “lupus anticoagulant” (LA) and antibodies to cardiolipin in serum, both strongly associated with thromboses.

Multiple venous and arterial thromboses associated with the lupus anticoagulant and antibodies to cardiolipin in the absence of SLE.

SummaryA 53-year-old man with a history of multiple venous thromboses presented with widespread occlusions of the abdominal arterial system associated with the presence of the “lupus anticoagulant” and antibodies to cardiolipin in serum. There was no serological evidence of systemic lupus erythematosus and vasculitis of the affected vessels was not evident on post mortem examination. The presence of these antibodies, associated with a tendency to thrombosis, positive anti nuclear factor and cryoglobulinaemia were the only indicators of an “auto-immune” disturbance in this patient.