Grossesses apres syndrome catastrophique des antiphospholipides: une tolerance clinique inattendue

La survenue d'un Syndrome Catastrophique des Antiphospholipides (SCAPL) contre-indique toute grossesse ulterieure. L'evolution spontanee d'une grossesse chez un terrain ayant un syndrome des antiphospholipides (SAPL) presente un taux d'echec entre 75et 90. La mortalite materno-foetale par SCAPL est de 50. La contraception definitive par ligature des trompes est alors obligatoire. Pourtant; les auteurs rapportent le cas d'une patiente qui a encore pu bien mener trois grossesses apres la survenue d'un SCAPL. Le suivi d'un protocole d'anticoagulation a ete exceptionnellement benefique

The Lupus Anticoagulant in a Population of Healthy Nigerian Adults

Patients with the antiphospholipid syndrome are at a high risk of recurrent thrombosis and recurrent fetal loss. Infertility and a number of other clinical manifestations have also been attributed to this syndrome. There are many tests for detecting the presence of the lupus anticoagulant but the most sensitive remains controversial. In this study we have used a combination of activated partial thromboplastin time (aPTT) and Kaolin clotting time (KCT) to determine the presence of the antibody in 125 healthy individuals which included pregnant women. Six (4.8) and four (3.2) of the subjects had elevated aPTT and a KCT ratio 1.2 respectively. The tests showed a high prevalence of the lupus anticoagulant in the multiparous group than the other groups while there is paucity of the anticoagulant in the pregnant women who are not at risk. We suggest the use of both aPTT and KCT for the screening of patients in whom the antiphospholipid syndrome is suspected. (SLE) [2] is sought for when a clinician suspects the presence of the inhibitor due to its recognized clinical features or an unexplained prolonged Activated Partial Thromboplastin Time (aPPT). There are various tests available for detecting the presence of the lupus anticoagulant but the most sensitive remains a controversy. The tests used are the aPPT [3]; kaolin clotting time (KCT)[4]; dilute Russell's viper venom time (RVVT)[5]; and the platelet neutralization test (PNT)[6]. At least two of these tests must be performed when investigating a patient suspected of having the lupus anticoagulant [6]. Detection of anticardiolipin antibody using enzyme linked immunosorbent assay is another test which is sensitive to the presence of the anticoagulant but this may not be practicable in a developing country set up. In this study the presence of the lupus anticoagulant was sought for in healthy individuals using the aPTT and the KCT