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Kidney Week

Abstract: PO2231

Therapeutic Plasma Exchange Improved Pregnancy Outcomes in a Patient with Triple Positive Anti-Phospholipid Antibody Syndrome

Session Information

Category: Women’s Health and Kidney Diseases

  • 2000 Women’s Health and Kidney Diseases

Authors

  • Al sanani, Ahlim, Marshall University Joan C Edwards School of Medicine, Huntington, West Virginia, United States
  • Poznanski, Noah John, Marshall University Joan C Edwards School of Medicine, Huntington, West Virginia, United States

Group or Team Name

  • Marshall University Joan C. Edwards School of Medicine- Department of Internal Medicine
Introduction

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by antibodies directed at platelet, monocyte, endothelial cell, and trophoblast moieties potentially causing venous and arterial thromboses. The placental vasculature is particularly vulnerable to
these antibodies resulting in a marked increased risk of fetal growth restriction, placental infarction, abruption, stillbirth, and preterm severe preeclampsia. APS is diagnosed by clinical criteria in conjunction with laboratory findings, and the circulating anti-phospholipid antibodies commonly tested are lupus anticoagulant, anti-cardiolipin, and anti-beta-2-glycoprotein-1. The simultaneous presence of all three antibodies is associated with the highest risk of thrombotic complications in APS.

Case Description

A 29-year-old nulligravida with medical history was significant for APS on lifelong coumadin. Her APS labs at the time of preconception visit showed elevated lupus anticoagulant ratio, anticardiolipin and anti-beta2-glycoprotein-1antibodies (Triple- positive antibodies). Medications included twice daily LMWH 60 mg and hydroxychloroquine 200 mg. Fetal anatomic survey at 20 weeks demonstrated normal fetal growth, however, by 21 weeks 6 days ultrasound showed absent-end diastolic flow of the umbilical artery Doppler waveform. She was admitted to the hospital. A pre-eclampsia workup was completed due to hypertension and new onset proteinuria. LDA daily, pravastatin 20mg was added. Due to the diagnosis of preeclampsia with severe features, the decision was made to treat with therapeutic plasma exchange.

Discussion

High-risk obstetric APS profiles are linked to specific serological markers such as triple antibody positivity, clinical features such as a history of thrombosis, and the presence of pregnancies result in a liveborn infant, with that rate dropping to 30% in patients who are triple systemic autoimmune diseases. Therapeutic plasma exchange every 48 hours successfully prolonged the pregnancy for 11 weeks, resulting in an optimal pregnancy outcome for both mother and infant given the initial dire clinical situation at a pre-viable gestation. The rationale for TPE every 48 hours was based on the experience in plasmapheresis use in Catastrophic Antiphospholipid Syndrome (CAPS)