Cáncer de mama triple negativo, abortos a repetición e isquemia digital grave / Triple negative breast cancer, repeated abortions and severe digital ischemia

Resumen El presente caso corresponde a una mujer con antecedentes de tres abortos de menos de 10 semanas y cáncer de mama, que desarrolló isquemia digital grave luego del segundo ciclo de capecitabina. Se determinó la presencia de anticuerpos antifosfolipídicos positivos. Dado que las pacientes con síndrome antifosfolipídico obstétrico tienen incremento del riesgo de desarrollar neoplasia y que la isquemia digital grave puede ser la forma de presentación del síndrome antifosfolipídico en los pacientes con cáncer, se presenta el caso para remarcar el beneficio de pesquisar y realizar un diagnóstico temprano de estas características de la enfermedad.

Abstract The present case corresponds to a woman with history of three miscarrieges less than10 weeks and breast cancer, who develops severe digital ischemia after the second cycle of capecitabine. Positive antiphospholipid antibodies were determined. Patients with obstetric antiphospholipid syndrome have an increased risk of developing cancer, and severe digital ischemia could be an unusual form of presentation of the antiphospholipid syndrome in patients with cancer. This case is presented to highlight the benefit of researching and making an early diagnosis of these characteristics of the disease.

Clinical characteristics and pregnancy outcomes of non-criteria obstetric antiphospholipid syndrome / 中华内科杂志

Objective:To study clinical characteristics and pregnancy outcomes under anti-coagulation therapy of non-criteria obstetric antiphospholipid syndrome.Methods:Patients suspected of obstetric antiphospholipid syndrome(OAPS) were recruited through Chinese Rheumatism Data Center from 2015 to 2019 consecutively. Patients fulfilling 2006 Sydney revised antiphospholipid syndrome criteria were classified as OAPS. Patients fulfilling definition of non-criteria OAPS(NCOAPS) by expert consensus on diagnosis and management of obstetric antiphospholipid syndrome of China were classified as NCOAPS. Clinical characteristics and laboratory results of two groups were compared. Live birth rates and pregnancy outcomes under anti-coagulation therapy were studied.Results:A total of 88 patients were enrolled, including 56 patients (63.6%) as OAPS, 32(36.4%) as NCOAPS. Live births were only reached in 16.1% (9/56) in OAPS patients and 12.5%(4/32) in NCOAPS. Fetal losses after 10 weeks of gestation and pre-eclampsia before 34 weeks were more common in OAPS group compared to NCOAPS group [78.6%(44/56) vs. 18.8%(6/32), P<0.001; 25.0%(14/56) vs. 3.1%(1/32), P=0.020, respectively]. After enrollment, 15 pregnancies were recorded in OAPS, 10 in NCOAPS, all of whom were treated with low-dose aspirin (LDA) combined with low-molecular weight heparin (LMWH). Live birth rates saw dramatic improvements compared to baseline levels in OAPS [16.1% (9/56) vs. 11/15] along with NCOAPS [12.5% (4/32) vs. 7/10]. Conclusion:Though NCOAPS and OAPS patients differ in antiphospholipid antibody spectrum and pattern of pregnancy morbidities, both groups benefit from LDA combined with LWMH treatment, as live birth rates improve. Non-criteria OAPS patients are recommended to receive anti-coagulation therapy during pregnancy.

Niveles de anticuerpos anti-anexina A5 y manifestaciones de síndrome antifosfolípido primario obstétrico / Levels of anti-anexinal antibodies A5 and manifestations of obstetric primary antiphospholipid syndrome

El Síndrome Antifosfolípidos (SAF) describe un trastorno trombofílico autoinmune caracterizado por complicaciones obstétricas. La Anexina A5 (Anx A5) es una proteína que se estudia como un nuevo autoantígeno presente en el SAF, la presencia de autoanticuerpos frente a Anx A5 podría causar trombosis placentaria y pérdida del embarazo. El objetivo de este estudio fue analizar los niveles de IgG e IgM anti-Anx A5 en mujeres con SAF primario obstétrico y su asociación con diferentes complicaciones en una población de la ciudad de Córdoba. Se trabajó con muestras de pacientes puérperas que asistieron al Hospital Córdoba y al Hospital Materno Neonatal durante los años 2013-2017 con diagnóstico de SAF obstétrico y un grupo control formado por pacientes con embarazos normales. En la mayoría de las pacientes estudiadas, los niveles de IgG e IgM anti-Anx A5 se encontraron por debajo del rango de referencia, se mostró un aumento estadísticamente significativo de los niveles de IgG en pacientes con SAF respecto al grupo control. Pero no existieron asociaciones específicas entre los niveles de anticuerpo y los tres tipos de manifestaciones clínicas presentes en los criterios de clasificación. Estos hallazgos podrían sugerir una relación entre los anticuerpos anti-Anx A5 con el SAF obstétrico.

Antiphospholipid Syndrome (APS) describes an autoimmune thrombophilic disorder characterized by obstetric complications. Annexin A5 (Anx A5) is a protein that is studied as a new autoantigen present in APS, the presence of autoantibodies against Anx A5 could cause placental thrombosis and possibly pregnancy loss. The aim of this study was to analyze levels of IgG and IgM anti-Anx A5 in women with primary obstetric APS and its association with different complications in a population of the city of Córdoba. We worked with samples of puerperal patients who attended the Córdoba Hospital and the Maternal Neonatal Hospital during the years 2013-2017 with a diagnosis of obstetric APS and a control group formed by patients with normal pregnancies. In most of the patients studied, levels of IgG and IgM anti-Anx A5 were below the reference range, is demonstrate an increase statistically significant in the levels of the IgG in patients with APS compared with control group. But there were no specific associations between antibody levels and the three types of obstetric clinical manifestations present in the classification criteria. These findings could suggest a relationship between anti-Anx A5 antibodies and obstetric APS.