title: Antiplatelet factor 4--heparin antibodies in patients with antiphospholipid antibodies.
abstract: Antibodies directed against platelet factor 4-heparin are present in patients with heparin-induced thrombocytopenia (HIT). Additionally, it has been suggested that heparin can be an antigenic target of antiphospholipid antibodies (aPL). We investigated the presence of heparin-platelet factor 4-induced antibodies (HPIA) in 33 patients with aPL. There were 30 patients with lupus anticoagulant, 25 with anticardiolipin antibodies, 21 with anti-beta2 glycoprotein I, and 18 with antiprothrombin antibodies. 20 patients had a history of thrombosis and 19 had received heparin during the last 60 months. We found 7 (21.2%) who had HPIA; 5 of them also had anti-beta2 glycoprotein I antibodies. Four patients had severe thrombocytopenia and suspicion of HIT. Among them, two presented high positive HPIA results, one of them with positive platelet aggregation test. The third patient showed grey zone HPIA and borderline aggregation test and the fourth one had negative results. Among patients without a history of HIT, 2 who had never received heparin presented high positive, one a moderate positive, and one a grey zone HPIA result; all of them with negative aggregation tests. Five positive sera samples were incubated with cardiolipin liposomes in the presence of beta2 glycoprotein I, and whereas an inhibition greater than 50% was achieved in anticardiolipin and anti-beta2 glycoprotein I activities, HPIA results did not change. We demonstrate that HPIA could be frequently found in patients with aPL. They are responsible for HIT in some cases but can also be found in patients who have not received heparin. Whether they predispose patients with aPL to HIT is not known; nevertheless, a close follow-up of heparin treatment in these patients seems to be mandatory.
authors.affiliation: Institute of Cardiology and Cardiovascular Surgery, Division of Haematology, Favaloro University, School of Medicine, Favaloro Foundation, Buenos Aires, Argentina.
authors.forename: M E
authors.initials: ME
authors.lastname: Martinuzzo
authors.forename: R R
authors.initials: RR
authors.lastname: Forastiero
authors.forename: Y
authors.initials: Y
authors.lastname: Adamczuk
authors.forename: G
authors.initials: G
authors.lastname: Pombo
authors.forename: L O
authors.initials: LO
authors.lastname: Carreras
mesh_terms: D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000097:blood* / Q000276:immunology; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000276:immunology*; D001323:Autoantibodies / Q000097:blood* / Q000276:immunology; D005260:Female; D006493:Heparin / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010978:Platelet Factor 4 / Q000276:immunology*
chemical_list: D017152:Antibodies, Antiphospholipid; D001323:Autoantibodies; D010978:Platelet Factor 4; D006493:Heparin