title: A comprehensive screening analysis of antiphospholipid antibodies in Indian women with fetal loss.
abstract: OBJECTIVE
  The present study was aimed at a comprehensive analysis of acquired thrombophilia in a large series of Indian women with fetal loss.
  
  
  METHODS
  Four hundred and thirty women (median age 26 years, range 18-39 years) with unexplained fetal loss (median number of abortions 3, range 1-13) were screened for the presence of antiphospholipid antibodies (APA), i.e. lupus anticoagulant (LA), IgG/M antibodies for cardiolipin (ACA), beta 2 glycoprotein 1 (beta2 GP1) and annexin V. We also studied 100 normal healthy women (median age 24 years, range 18-30 years) who had at least one healthy child and did not have any miscarriage or other obstetric complications.
  
  
  RESULTS
  The prevalence of persistently positive LA was 8.1% and 1% in the patients and controls, respectively (OR 8.7; 95% CI, 1.4-51; P<0.05). The overall prevalence of IgG and/or IgM antibodies for cardiolipin, beta 2 GP1 and annexin V were as follows-ACA 27.9% (OR 18.9; 95% CI, 5-70; P<0.05), beta 2 GP1 12.2% (OR 6.8; 95% CI, 1.8-25; P<0.05) and annexin V 14.6% (OR 17; 95% CI, 2.9-98; P<0.05). The conventional LA and ACA tests were positive 23.2% of the cases as against 1% in the controls (OR 14.8; 95% CI, 3.9-55; P<0.05). The prevalence of LA, ACA, beta 2 GP1 and annexin V antibodies as independent risk factors were observed in 0.5%, 16.5%, 5.4% and 7.8% in the patients as against 1% each in the controls. The overall positivity for any one of the APA studied was 42.6% (OR 10.2; 95% CI, 4.5-23; P<0.05).
  
  
  CONCLUSIONS
  The present study thus indicates the importance of APA in women experiencing fetal loss where all the conventional causes of miscarriages have been ruled out. It also suggests that conventional APA assays (LA and ACA) are effective in the detection of a majority of APA positive cases and by the addition of other cofactor-dependent (beta 2 GP1 and annexin V) APA assays, there is a considerable increase in the diagnostic efficiency in the detection of APA.
authors.affiliation: Institute of Immunohaematology (ICMR), KEM Hospital, Parel, Mumbai 400012, India.
authors.forename: Sonal
authors.initials: S
authors.lastname: Vora
authors.forename: Shrimati
authors.initials: S
authors.lastname: Shetty
authors.forename: Vinita
authors.initials: V
authors.lastname: Salvi
authors.forename: Purnima
authors.initials: P
authors.lastname: Satoskar
authors.forename: Kanjaksha
authors.initials: K
authors.lastname: Ghosh
mesh_terms: D000022:Abortion, Spontaneous / Q000097:blood / Q000209:etiology / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D017304:Annexin A5 / Q000276:immunology; D000906:Antibodies / Q000097:blood; D017152:Antibodies, Antiphospholipid / Q000097:blood*; D002308:Cardiolipins / Q000276:immunology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016682:Lupus Coagulation Inhibitor / Q000097:blood; D008403:Mass Screening / Q000379:methods*; D011247:Pregnancy; D019851:Thrombophilia / Q000276:immunology; D053482:beta 2-Glycoprotein I / Q000276:immunology
chemical_list: D017304:Annexin A5; D000906:Antibodies; D017152:Antibodies, Antiphospholipid; D002308:Cardiolipins; D016682:Lupus Coagulation Inhibitor; D053482:beta 2-Glycoprotein I