Should Asymptomatic Pediatric Patients With Prolonged PTT Be Screened for LAC?

Children with prolonged partial thromboplastin time (PTT) should be screened for lupus anticoagulant (LAC), regardless of their history of bleeding problems, according to a study conducted by researchers at Louisiana State University Health Sciences Center Children’s Hospital, New Orleans, LA

Chandra Kallanagowdar, MD, and colleagues conducted a record-based retrospective analysis of 112 pediatric patients with abnormal coagulation profiles or a history of mucocutaneous bleeding.

The researchers collected data from records of children treated at Children’s Hospital of New Orleans during a 3-year period. Each patient was followed up for PTT and LAC every 12 weeks until all laboratory values returned to the reference range.

After a repeated coagulation profile, 75% of patients were found to have prolonged PPT; 21% of that population was found to be LAC positive. The LAC positive population was 67% female with a mean age of 6.05 years.  

Further evaluation showed that 89% of the LAC-positive patients were clinically asymptomatic, and 10 of those patients later became LAC-negative.

“Based on our study results, we conclude that LAC is common in children and adolescents with abnormal hematologic parameters, and is associated with asymptomatic presentation notable for prolonged PTT that may come to medical attention in the context of preoperative evaluation,” said Dr Kallanagowdar.

Summary and Clinical Applicability

“[LAC] has principally been studied in the adult population,” noted Dr Kallanagowdar. “…Scarce literature is available regarding LAC in the pediatric age group.”

The researchers note that most physicians agree that LAC is a benign condition lacking significant clinical issues, although reports do exist of LAC-associated thrombosis and bleeding episodes.

Patients who experience these complications may be positive for coexisting conditions such as factor deficiency, systemic lupus erthematosus, and antiphospholipid antibody syndrome. An association also exists between LAC and autoimmune conditions  such as rheumatoid arthritis, malignancies, urticaria, vasculitis, and lymphoproliferative disorders.

Limitations and Disclosures

One  notable limitation of the study is its retrospective nature; another limitation is that participants were followed only until their PTT values normalized.

“Future work could focus on the longitudinal effects of LA positivity, with or without the resolution of prolonged PTT who are not positive for LA to elucidate how prolonged PTT in the context of LA positivity differs from prolonged PTT because of other hematologic anomalies,” Dr Kallanagowar concluded.

Reference

Kallanagowdar C, Chauhan A, Puertolas MV, et al. Prevalence and resolution of lupus anticoagulant in children. Oschner J. 2016;61(2):172-175.