title: Incidence of Antiphospholipid Antibodies in Patients With Immune Thrombocytopenia and Correlation With Treatment With Steroids in North Indian Population.
abstract: BACKGROUND
  Antiphospholipid antibodies (APLAs) have been variably reported in 14% to 75% of patients with immune thrombocytopenia (ITP). There is lack of Indian data on incidence of APLA in ITP.
  
  
  OBJECTIVE
  We studied the incidence of APLA in patients with pediatric and adult Indian ITP.
  
  
  METHODS
  We prospectively studied 100 patients including acute (n = 37), persistent (n = 13), and chronic (n = 50) ITP. Male to female ratio was 1.22:1. Median age was 18 years (1.5-56). All patients underwent investigations for lupus anticoagulant (LA), anticardiolipin (aCL) immunoglobulin G (IgG) and IgM antibodies, and anti-β2 glycoprotein 1 (β2GP1) IgG and IgM antibodies. Patients with secondary ITP were excluded. Bleeding manifestations were recorded. Patients with acute and persistent ITP were assessed for steroid response. Response rates were compared between APLA-positive and APLA-negative patients.
  
  
  RESULTS
  Antiphospholipid antibodies were detected in ∼12% of patients with ITP: 8.1% (3 of 37) in acute, 0% (0 of 13) in persistent, and 18% (9 of 50) in chronic ITP. Anti-β2GP1 antibodies were most frequent (9%). Only 2 patients each were positive for anti-aCL antibodies and LA. Although platelet counts were significantly higher in APLA-positive patients, there was no significant difference in bleeding between the APLA-positive versus APLA-negative patients with ITP. There was also no significant difference in steroid response between APLA-positive and APLA-negative patients with acute/persistent ITP. In the short follow-up (median 8 months), none of the APLA-positive patients developed thrombosis.
  
  
  CONCLUSIONS
  Incidence of APLA in Indian population was lower than reported in the West, which indicates that not all patients of ITP need to be subjected to these manifestations upfront at diagnosis.
authors.affiliation: 1 Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Aniruddha
authors.initials: A
authors.lastname: Dayama
authors.affiliation: 1 Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.|2 Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Jasmita
authors.initials: J
authors.lastname: Dass
authors.affiliation: 1 Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Manoranjan
authors.initials: M
authors.lastname: Mahapatra
authors.affiliation: 1 Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Renu
authors.initials: R
authors.lastname: Saxena
mesh_terms: D000293:Adolescent; D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006470:Hemorrhage; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology*; D013256:Steroids / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D017152:Antibodies, Antiphospholipid; D013256:Steroids
keywords: immunology; lupus inhibitor; thrombocytopenia