Pregnancy outcomes of antiphospholipid syndrome: In a low resource South Asian setting.

PROBLEM: Antiphospholipid syndrome is associated with recurrent pregnancy loss, and specific treatment improves pregnancy outcome. Laboratory diagnosis is limited in South Asia. We assessed management outcomes of definite/probable antiphospholipid syndrome treated at a tertiary centre in Sri Lanka. METHOD: Descriptive cross-sectional study of pregnancy outcomes with heparin and aspirin therapy. OUTCOME MEASURES: miscarriage, intrauterine death and live birth when compared to previous untreated pregnancies. RESULTS: Of 646 gestations in 145 women, 146 (22.6%) received specific treatment. In the preceding pregnancies without specific treatment, the rates of miscarriage, late fetal loss, stillbirth and live birth were 60%, 26%, 8% and 7%, respectively. Following specific treatment with low-dose aspirin ± low-molecular weight heparin in 146 pregnancies (145 women), the rates of miscarriage, late fetal loss, stillbirth and live birth were 14%, 10%, 3% and 74%, respectively. Mean birth weight was 2.54 ± 0.62 kg, preterm births complicated 32 (29.6%) with a mean gestational age at delivery 33.7 ± 2.6 weeks, with three neonatal deaths. Maternal complications were: pre-eclampsia 16 (10.9%), gestational diabetes 28 (19.2%), antepartum haemorrhage in 1 patient. Only 73/145 (50.3%) women had laboratory confirmation of antiphospholipid syndrome, while others were treated empirically. Live births in diagnosed vs. empiric treatment - 80.8% vs. 67.1%. CONCLUSION: Pregnant women with clinical antiphospholipid syndrome when treated with low-dose aspirin and heparin, the live birth rate of 7% in the previous pregnancy resulted in live births of 74% in a resource limited South Asian setting.

Acute leukaemia of ambiguous lineage--a diagnostic dilemma.

Acute leukaemia of ambiguous lineage (ALAL) is a rare form of leukaemia in which morphologic, cytochemical and immuno-phenotypic features of the proliferating blasts lack sufficient evidence to classify them as myeloid or lymphoid in origin or have characteristics of both myeloid and lymphoid cells. We report a 22-year-old man presenting with clinical features of an acute lymphoblastic leukaemia but blasts in his blood and bone marrow with morphological features of myeloblasts. His immuno-phenotyping by flowcytometry showed antigens specific for both myeloid and B-lymphoid lineages. We highlight the importance of correlating clinical features with cellular morphology when diagnosing acute leukaemias, especially when facilities for flowcytometry are not routinely available.