Skip to main content

Management of Thrombocytopenia in Hughes Syndrome

  • Chapter
  • 724 Accesses

Conclusions and Future Perspectives

Moderate thrombocytopenia is frequent in Hughes syndrome and, as a rule, does not modify the policy for treatment of thrombosis. Severe thrombocytopenia is relatively uncommon and it is seldom associated with bleeding events. When required, its treatment is similar to that of idiopathic thrombocytopenic purpura. Finally, much clinical and laboratory work is still required to elucidate the role of aPL antibodies and platelets in the pathogenesis of the thrombotic complications typical of Hughes syndrome.

Keywords

  • Systemic Lupus Erythematosus
  • International Normalize Ratio
  • Idiopathic Thrombocytopenic Purpura
  • Italian Registry
  • Lupus Anticoagulant

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (Canada)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   129.00
Price excludes VAT (Canada)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (Canada)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   169.99
Price excludes VAT (Canada)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Asherson RA, Khamashta MA, Ordi-Ros J, et al. The “primary” antiphospholipid syndrome: major clinical and serological features. Medicine (Baltimore) 1989;68:366–374.

    PubMed  CAS  Google Scholar 

  2. Alarcon-Segovia D, Deleze M, Oria CV. Antiphospholipid antibodies and the antiphospholipid sindrome in systemic lupus erythematosus: a review of 500 consecutive cases. Medicine (Baltimore) 1989;68:353–365.

    PubMed  CAS  Google Scholar 

  3. Wilson WA, Gharavi AE, Koike T, et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome. Arthritis Rheum 1999;42:1309–1311.

    CrossRef  PubMed  CAS  Google Scholar 

  4. Lechner K, Pabinger-Fasching I. Lupus anticoagulant and thrombosis. Hemostasis 1985;15:252–262.

    Google Scholar 

  5. Finazzi G, Brancaccio V, Moia M, et al. Natural history and risk factors of thrombosis in 360 patients with antiphospholipid antibodies. A four-year prospective study from the Italian Registry. Am J Med 1996;100:530–536.

    CrossRef  PubMed  CAS  Google Scholar 

  6. Italian Registry of Antiphospholipid Antibodies (IR-APA). Thrombosis and thrombocytopenia in antiphospholipid syndrome (idiopatic and secondary to SLE): first report from the Italian Registry. Haematologica 1993;78:313–318.

    Google Scholar 

  7. Barbui T, Cortelazzo S, Galli M, et al. Antiphospholipid antibodies in early repeated abortions: a case-control study. Fertil Steril 1988;50:589–592.

    PubMed  CAS  Google Scholar 

  8. De Wolf F, Carreras LO, Moerman P, Vermylen J, Van Assche A, Renaer M. Decidual vasculopathy and estensive placental infarction in a patient with repeated thrombembolic accidents, recurrent fetal loss and a lupus anticoaguant. Am J Obstet Gynecol 1982;142:829–834.

    PubMed  Google Scholar 

  9. Galli M, Finazzi G, Barbui T. Thrombocytopenia in the antiphospholipid syndrome. Br J Haematol 1996;93:1–5.

    CrossRef  PubMed  CAS  Google Scholar 

  10. Kuniki TJ, Newman PJ. The molecular immunology of platelet proteins. Blood 1992;80:1386–1404.

    Google Scholar 

  11. Harrington WJ, Minnich W, Hollingsworth WJ, Moore CV. Demonstration of a thrombocytopenic factor in the blood of patients with thrombocytopenic purpura. J Lab Clin Med 1951;38:1–10.

    PubMed  CAS  Google Scholar 

  12. Aster RH, Jandl JH. Platelet sequestration in man. II. Immunological and clinical studies. J Clin Invest 1962;43:856–869.

    CrossRef  Google Scholar 

  13. Harris EN, Gharavi AE, Hedge U, et al. Anticardiolipin antibodies in autoimmune thrombocytopenic purpura. Br J Haematol 1985;59:231–234.

    PubMed  CAS  Google Scholar 

  14. Galli M, Daldossi M, Barbui T. Anti-glycoprotein Ib/IX and IIb/IIIa antibodies in patients with antiphospholipid antibodies. Thromb Haemost 1994;71:571–575.

    PubMed  CAS  Google Scholar 

  15. He R, Reid DM, Jones CE, Shulman NR. Spectrum of IgG classes, specificities and titers of serum antiglycoproteins in chronic idiopathic thrombocytopenic purpura. Blood 1994;83:1024–1032.

    PubMed  CAS  Google Scholar 

  16. Fabris F, Steffan A, Cordiano L, et al. Specific antiplatelet autoantibodies in patients with antiphospholipid antibodies and thrombocytopenia. Eur J Haematol 1994;53:232–236.

    CrossRef  PubMed  CAS  Google Scholar 

  17. Godeau B, Piette J-C, Fromont P, Intrator L, Schaeffer A, Bierling P. Specific antiplatelet autoantibodies are associated with the thrombocytopenia of primary antiphospholipid syndrome. Br J Haematol 1997;98:873–879.

    CrossRef  PubMed  CAS  Google Scholar 

  18. Stasi R, Stipa E, Masi O, et al. Prevalence and clinical significance of elevated antiphospholipid antibodies in patients with idiopathic thrombocytopenic purpura. Blood 1994;84:4203–4207.

    PubMed  CAS  Google Scholar 

  19. McNeil HP, Simpson RJ, Chesterman CN, Krilis SA. Antiphospholipid antibodies are directed against a complex antigen that includes a lipid-binding inhibitor of coagulation: β2-glycoprotein I (apolipoprotein H). Proc Natl Acad Sci U S A 1990;87:4120–4124.

    CrossRef  PubMed  CAS  Google Scholar 

  20. Galli M, Comfurius P, Maassen C, et al. Anticardiolipin antibodies (ACA) directed not to cardiolipin but to a plasma protein cofactor. Lancet 1990;334:1544–1547.

    CrossRef  Google Scholar 

  21. Matsuura E, Igarashi Y, Fujimoto M, Ichikawa K, Koike T. Anticardiolipin cofactor(s) and differential diagnosis of autoimmune disease. Lancet 1990;335:177–178.

    CrossRef  Google Scholar 

  22. Bevers EM, Galli M, Barbui T, Comfurius P, Zwaal RFA. Lupus anticoagulant IgG’s (LA) are not directed to phospholipids only, but to a complex of lipid-bound human prothrombin. Thromb Haemost 1991;66:629–632.

    PubMed  CAS  Google Scholar 

  23. Zwaal RFA, Schroit AJ. Pathophysiologic implications of membrane phospholipid asymmetry in blood cells. Blood 1997;89:1121–1132.

    PubMed  CAS  Google Scholar 

  24. Martinuzzo ME, Mclouf J, Carreras LO, Levy-Toledano S. Antiphospholipid antibodies enhance thrombin induced platelet activation and thromboxane formation. Thromb Haemost 1993;70:667–671.

    PubMed  CAS  Google Scholar 

  25. Galli M, Cortelazzo S, Viero P, Finazzi G, de Gaetano G, Barbui T. Interactions between platelets and lupus anticoagulant. Eur J Haematol 1988;88–94.

    Google Scholar 

  26. Biasiolo A, Pengo V. Antiphospholipid antibodies are not present in the membrane of gel-filtered platelets of patients with IgG anticardiolipin antibodies, lupus anticoagulant and thrombosis. Blood Coag Fibrinolysis 1993;4:425–428.

    CAS  Google Scholar 

  27. Fanelli A, Bergamini C, Rapi S, et al. Flow cytometric detection of circulating activated platelets in primary antiphospholipid sindrome. Correlation with thrombocytopenia and anticardiolipin antibodies. Lupus 1997;6:261–267.

    PubMed  CAS  Google Scholar 

  28. Joseph JE, Harrison P, Mackie IJ, Machin SJ. Platelet activation markers and the primary antiphospholipid syndrome (PAPS). Lupus 1998;7:S48–S51.

    CrossRef  PubMed  CAS  Google Scholar 

  29. Joseph JE, Harrison P, Mackie IJ, Isenberg DA, Machin SJ. Increased circulating platelet-leukocyte complexes and platelet activation in patients with antiphospholipid syndrome, systemic lupus erythematosus and rheumatoid arthritis. Br J Haematol 2001;115:451–459.

    CrossRef  PubMed  CAS  Google Scholar 

  30. Out HJ, de Groot P, van Vliet M, de Gast GC, Niewenhuis HK, Derksen RHWM. Antibodies to platelets in patients with antiphospholipid antibodies. Blood 1991;77:2655–2659.

    PubMed  CAS  Google Scholar 

  31. Shechter Y, Tal Y, Greenberg A, Brenner B. Platelet activation in patients with antiphospholipid syndrome. Blood Coag Fibrinolysis 1998;9:653–657.

    CAS  Google Scholar 

  32. Galli M, Grassi A, Barbui T. Platelet-derived microvesicles in patients with antiphospholipid antibodies [abstract]. Thromb Haemost 1993;69:541.

    Google Scholar 

  33. Khamashta MA, Harris EN, Gharavi AE, et al. Immune mediated mechanism for thrombosis: antiphospholipid antibody binding to platelet membrane. Ann Rheum Dis 1988;47:849–852.

    CrossRef  PubMed  CAS  Google Scholar 

  34. Hasselaar P, Derksen RHWM, Blokzijl L, de Groot P. Cross-reactivity of antibodies directed against cardiolipin, DANN, endothelial cells and blood platelets. Thromb Haemost 1990;63:169–173.

    PubMed  CAS  Google Scholar 

  35. Mikhail MH, Szczech LAM, Shapiro SS. The binding of lupus anticoagulant (LACs) to human platelets [abstract]. Blood 1988;72:333.

    Google Scholar 

  36. Shi W, Chong BH, Chesterman CN. β2-glycoprotein I is a requirement for anticardiolipin antibody binding to activated platelets: differences with lupus anticoagulants. Blood 1993;81:1255–1262.

    PubMed  CAS  Google Scholar 

  37. Arvieux J, Roussel B, Pouzol P, Colomb MG. Platelet activating properties of murine monoclonal antibodies to beta2-glycoprotein I. Thromb Haemost 1993;70:336–341.

    PubMed  CAS  Google Scholar 

  38. Arvieux J, Jacob MC, Roussel B, Bensa JC, Colomb MG. Neutrophil activation by anti-β2-glycoprotein I monoclonal antibodies via Fcã receptor II. J Leukoc Biol 1995;57:387–394.

    PubMed  CAS  Google Scholar 

  39. Font J, Espinosa G, Tassies D, et al. Etteftc of beta2-glycoprotein I and monoclonal anticardiolipin antibodies in platelet interaction with subendothelium under flow conditions. Arthritis Rheum 2002;46:3283–3289.

    CrossRef  PubMed  CAS  Google Scholar 

  40. Lutters BC, Derksen RH, Tekelenburg WL, Lenting WL, Arout H, de Groot PG. Dimers of beta2-glycoprotein I increase platelet deposition to collagen via interaction with phospholipids and the apolipoprotein E receptor 2’. J Biol Chem 2003;278:33831–33838.

    CrossRef  PubMed  CAS  Google Scholar 

  41. Nojima J, Suehisa E, Kuratsune H, et al. Platelet activation induced by combined effects of anticardiolipin and lupus anticoagulant IgG antibodies in patients with systemic lupus erythematosus. Thromb Haemost 1999;81:436–441.

    PubMed  CAS  Google Scholar 

  42. Arnout J. The pathogenesis of antiphospholipid syndrome: a hypothesis based on parallelisms with heparin-induced thrombocytopenia. Thromb Haemost 1997;75:536–541.

    Google Scholar 

  43. George JN, Alving B, Ballem P. Immune heparin-induced thrombocytopenia and thrombosis. Nashville TN: Educational Program of the American Society of Hematology; 1994:66–68.

    Google Scholar 

  44. Green D, Harris K, Reynolds N, Roberts M, Patterson R. Heparin immune thrombocytopenia: evidence for a heparin-platelet complex as the antigenic determinant. J Lab Clin Med 1978;91:167–175.

    PubMed  CAS  Google Scholar 

  45. Greinacher A, Michel I, Mueller-Eckhardt C. Heparin-associated thrombocytopenia: the antibody is not heparin specific. Thromb Haemost 1992;67:545–549.

    PubMed  CAS  Google Scholar 

  46. Chong BH, Pitney WR, Castaldi PA. Heparin-induced thrombocytopenia: association with thrombotic complications with heparin-dependent IgG antibody that induces thromboxane synthesis and platelet aggregation. Lancet 1982;ii:1246–1249.

    CrossRef  Google Scholar 

  47. Kappa JR, Fisher CA, Addonizio VP Jr. Heparin-induced platelet activation: the role of thromboxane A2 synthesis and the extent of platelet granule release in two patients. J Vasc Surg 1989;9:574–579.

    CrossRef  PubMed  CAS  Google Scholar 

  48. Warkentin TE, Hayward CP, Boshkov LK, et al. Sera from patients with heparin-induced thrombocytopenia generate thrombi-derived microparticles with procoagulant activity: an explanation for the thrombotic complications of heparin-induced thrombocytopenia. Blood 1994;84:3691–3699.

    PubMed  CAS  Google Scholar 

  49. Burgess JK, Lindeman R, Chesterman CN, Chong BH. Single aminoacid mutation of Fcγ receptor is associated with the development of heparin-induced thrombocytoenia. Br J Haematol 1995;91:3691–3699.

    Google Scholar 

  50. Warderman PAM, van de Winkel JGJ, Vlug A, Esterdaal NAC, Capel PJA. A single aminoacid in the second Ig-like domain of the human Fcγreceptor II is critical for the human IgG2 binding J Immunol 1991;147:1338–1343.

    Google Scholar 

  51. Arepally G, Poncz M, McKanzie SE, Cines D. Charactierization of antibody subclass specificity and antigenic determinants in heparin-associated thrombocytopenia [abstract]. Blood 1994;84:181.

    Google Scholar 

  52. Arvieux J, Roussel B, Ponard D, Colomb MG. IgG2 subclass restriction af anti β2-glycoprotein I antibodies in autoimmune patients. Clin Exp Immunol 1994;95:310–315.

    CrossRef  PubMed  CAS  Google Scholar 

  53. Atsumi T, Caliz R, Amengual O, Khamashta MA, Hughes GRV. Fcγreceptor IIa H/R 131 polymorphism in patients with antiphospholipid antibodies. Thromb Haemost 1998;79:924–927.

    PubMed  CAS  Google Scholar 

  54. Vermylen J, Hoylaerts MF, Arnout J. Antibody-mediated thrombosis. Thromb Haemost 1997;78:420–426.

    PubMed  CAS  Google Scholar 

  55. Willems G, Janssen MP, Pelsers MMAL, et al. Role of divalency in the high-affinity binding of anticardiolipin antibody-β2-glycoprotein I complexes to lipid membranes. Biochemistry 1996;35:13833–13842.

    CrossRef  PubMed  CAS  Google Scholar 

  56. Willems GM, Janssen MP, Comfurius P, Galli M, Zwaal RFA, Bevers EM. Kinetics of prothrombinmediated binding of lupus anticoagulant antibodies to phosphatidylserine-containing phospholipid membranes: an ellipsometric study. Biochemistry 2002;41:14357–14363.

    CrossRef  PubMed  CAS  Google Scholar 

  57. Nojima J, Suehisa E, Kuratsune H, et al. High prevalence of thrombocytopenia in SLE patients with high levels of anticardiolipin antibodies combined with lupus anticoagulant. Am J Hematol 1998:58:55–60.

    CrossRef  PubMed  CAS  Google Scholar 

  58. Diz-Kucukkaya R, Hacihanefioglu, Yenerel M, et al. Antiphospholipid antibodies and antiphospholipid syndrome in patients presenting with immune thrombocytopenic purpura: a prospective cohort study. Blood 2001;98:1760–1764.

    CrossRef  PubMed  CAS  Google Scholar 

  59. Jankowski M, Vreys I, Wittevrongel C, et al. Thrombogenicity of beta2-glycoprotein I-dependent antiphospholipid antibodies in a photochemically induced thrombosis model in the hamster. Blood 2003;101:157–162.

    CrossRef  PubMed  CAS  Google Scholar 

  60. Barbui T, Finazzi G. Clinical trials on antiphospholipid syndrome: what is being done and what is needed? Lupus 1994;3:303–307.

    PubMed  CAS  Google Scholar 

  61. Machin SJ. Platelets and antiphospholipid antibodies. Lupus 1996;5:386–387.

    PubMed  CAS  Google Scholar 

  62. Cortelazzo S, Finazzi G, Buelli M, Molteni A, Viero P, Barbui T. High risk of severe bleeding in aged patients with chronic idiopathic thrombocytopenic purpura. Blood 1991;71:31–33.

    Google Scholar 

  63. Drenkard C, Villa AR, Alarcon-Segovia D, Perez-Vazquez ME. Influence of the antiphospholipid sindrome in the survival of patients with systemic lupus erythematosus. J Rheumatol 1994;21:1067–1072.

    PubMed  CAS  Google Scholar 

  64. Stasi R, Stipa E, Masi M, Cecconi M, et al. Long-term observation of 108 adults with chronic idiopathic thrombocytopenic purpura. Am J Med 1995;98:436–442.

    CrossRef  PubMed  CAS  Google Scholar 

  65. Galli M, Finazzi G, Barbui T. Thrombocytopenia in the antiphospholipid sindrome. Br J Haematol 1996;93:1–5.

    CrossRef  PubMed  CAS  Google Scholar 

  66. Stasi R, Pagano A, Stipa E, Amadori S. Rituximab chimeric anti-CD20 monoclonal antibody treatment for adults with chronic idiopathic thrombocytopenic purpura. Blood 2001;98:952–957.

    CrossRef  PubMed  CAS  Google Scholar 

  67. Stasi R, Stipa E, Forte V, Meo P, Amadori S. Variable patterns of response to rituximab treatment in adults with chronic idiopathic thrombocytopenic purpura. Blood 2002;99:3872–3873.

    CrossRef  PubMed  CAS  Google Scholar 

  68. Giagoudinis AA, Anhuf J, Schneider P, et al. Treatment of relapsed idiopathic thrombocytopenic purpura with the anti-CD20 antibody rituximab. Eur J Haematol 2002;69:95–100.

    CrossRef  Google Scholar 

  69. Zaja F, Vinelli N, Sperotto A, et al. The B-cell compartment as the selective target for the treatment of immune thrombocytopenias. Haematologica 2003;88:538–546.

    PubMed  Google Scholar 

  70. Binstadt BA, Caldas AM, Turvey SE, et al. Rituximab therpy for multisystem autoimmune diseases in pediatric patients. J Pediatr 2003;143:598–604.

    CrossRef  PubMed  CAS  Google Scholar 

  71. Voog E, Brice P, Cartron J. Acute agranulocytosis (AA) in three patients treated with rituximab for non-Hodgkin lymphoma [abstract]. Blood 2001;98:4668a.

    Google Scholar 

  72. Mehta AC, Mtanos GJ, Gentile TC. Exacerbation of lupus while receiving rituximab for chronic refractory thrombocytopenia [abstract]. Blood 2001;98:3862a.

    Google Scholar 

  73. Cohen AJ, Philip TM, Kessler CM. Circulating coagulation inhibitors in the acquired immunodeficiency syndrome. Ann Int Med 1986;104:175–180.

    PubMed  CAS  Google Scholar 

  74. Orlando E, Cortelazzo S, Marchetti M, Sanfratello R, Barbui T. Prolonged bleeding time in patients with lupus anticoagulant. Thromb Haemost 1992;68:495–499.

    PubMed  CAS  Google Scholar 

  75. Manoharan A, Gottlieb P. Bleeding in patients with lupus anticoagulant. Lancet 1984;ii:171.

    CrossRef  Google Scholar 

  76. Ordi J, Vilardell M, Oristell J, et al. Bleeding in patients with lupus anticoagulant. Lancet 1984;ii:868–869.

    CrossRef  Google Scholar 

  77. Rosove MH, Brewer PMC. Antiphospholipid antibodies: clinical course after the first thrombotic event in 70 patients. Ann Intern Med 1992;117:303–308.

    PubMed  CAS  Google Scholar 

  78. Khamashta MA, Cuadrado MJ, Mujic F, Taub MA, Hunt BJ, Hughes GRV. The management of thrombocytopenia in the antiphospholipid antibody syndrome. N Engl J Med 1995;332:993–997.

    CrossRef  PubMed  CAS  Google Scholar 

  79. Ginsberg JS, Wells PS, Brill-Edwards P, et al. Antiphospholipid antibodies and venous thromboembolism. Blood 1995;86:3685–3691.

    PubMed  CAS  Google Scholar 

  80. Prandoni P, Simioni P, Girolami A. Antiphospholipid antibodies, recurrent thromboembolism, and intensity of warfarin anticoagulation [letter]. Thromb Haemost 1996;75:859.

    PubMed  CAS  Google Scholar 

  81. Shulman S, Svegnusson E, Granqvist S, and the Duration of Anticoagulation Study Group. Anticardiolipin antibodies predict early recurrence of thrombembolism and death among patients with venous thromboembolism following anticoagulant therapy. Am J Med 1998;104:332–338.

    CrossRef  Google Scholar 

  82. Cortelazzo S, Finazzi G, Viero P, et al. Thrombotic and haemorrhagic complications in patients with mechanical heart valve prosthesis attendine an anticoagulation clinic. Thromb Haemost 1993;69:316–320.

    PubMed  CAS  Google Scholar 

  83. Crowther MA, Ginsberg JS, Julian J, et al. A comparison of two intensities of warfarin for the prevention of recurrent thrombosis in patients with the antiphospholipid syndrome. N Engl J Med 2003;349:1133–1138.

    CrossRef  PubMed  CAS  Google Scholar 

  84. The APASS Investigators. Antiphospholipid antibodies and subsequent thrombo-occlusive events in patients with ischemic stroke. JAMA 2004;291:576–584.

    CrossRef  Google Scholar 

  85. Finazzi G on behalf of the members of the Italian Registry. The Italian Registry of antiphospholipid antibodies [abstract 44]. Blood 2003;102:16a.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2006 Springer-Verlag London Limited

About this chapter

Cite this chapter

Galli, M., Barbui, T. (2006). Management of Thrombocytopenia in Hughes Syndrome. In: Khamashta, M.A. (eds) Hughes Syndrome. Springer, London. https://doi.org/10.1007/1-84628-009-5_45

Download citation

  • DOI: https://doi.org/10.1007/1-84628-009-5_45

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-85233-873-2

  • Online ISBN: 978-1-84628-009-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics