EXTENDED REPORT

Value of IgA anticardiolipin and anti-ß₂-glycoprotein I antibody testing in patients with pregnancy morbidity

S Carmo-Pereira^1,2, M L Bertolaccini¹, A Escudero-Contreras^1,3, M A Khamashta¹, G R V Hughes¹

¹ Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, London, UK
² Department of Medicine I, Hospital Santa Maria, Lisbon, Portugal
³ Rheumatology Department, Hospital Universitario Reina Sofia, Cordoba, Spain

Correspondence to:
Correspondence to:
Dr M A Khamashta, Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, London SE1 7EH, UK;
munther.khamashta{at}kcl.ac.uk

Objective: To study the prevalence of IgA antiphospholipid antibodies, particularly anticardiolipin antibodies (aCL) and anti-ß₂-glycoprotein I (aß₂GPI), in a cohort of patients with pregnancy morbidity.

Patients and methods: Serum samples from four groups of patients were studied by an in house enzyme linked immunosorbent assay (ELISA). Group I: 28 patients with primary antiphospholipid syndrome (PAPS) (median age 32.5 years, range 25–34). Twelve patients had a history of thrombosis. All were positive for IgG/M aCL or lupus anticoagulant (LA), or both. Group II: 28 patients with unexplained pregnancy morbidity (median age 35 years, range 23–48). Seven had history of thrombosis. Nine patients were positive for IgG/M aCL. None from this group fulfilled Sapporo criteria for APS. Group III: 28 patients with systemic lupus erythematosus (SLE) (median age 34 years, range 25–52). Eleven had a history of thrombosis. Twenty one patients had IgG/M aCL and/or LA, but only 19 fulfilled Sapporo criteria for APS.

Results: IgA aCL were found in 12, 6, and 14 patients from the groups with PAPS, unexplained pregnancy morbidity, and SLE, respectively. Most patients had these antibodies together with IgG/IgM aCL. Three patients from the group with unexplained pregnancy morbidity and two with SLE had IgA aCL alone. IgA aß₂GPI was present in one patient from each group. All IgA aß₂GPI were present together with IgG and/or IgM aß₂GPI.

Conclusions: The prevalence of IgA aCL is high in patients with pregnancy morbidity, although IgA aCL are usually present together with IgG and/or IgM aCL. IgA aß₂GPI are not useful in identifying additional women with APS and pregnancy morbidity.

Keywords: antiphospholipid syndrome; miscarriages; fetal death; thrombosis; lupus anticoagulant

Abbreviations: aß₂GPI, anti-ß₂-glycoprotein I; aCL, anticardiolipin antibodies; aPL, antiphospholipid antibodies; BSA, bovine serum albumin; ELISA, enzyme linked immunosorbent assay; LA, lupus anticoagulant; PAPS, primary antiphospholipid syndrome; PBS, phosphate buffered saline; SLE, systemic lupus erythematosus

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