Coagulation and Fibrinolysis Study in Systemic Lupus erythematosus: Haematological, Urinary and Tissue Parameters^[*]

Summary

Haematochemical, urinary and tissue parameters were examined in the elaboration of the coagulation and fibrinolysis profile in 33 cases of systemic lupus erythematosus in different stages of the disease. Coagulation abnormalities varied from hypo- to hyper-coagulabitity, these being often associated in the same patient, either simultaneously or at different stages of the disease. Activation of coagulation, closely related to the immunological activity of the disease, was present in 80% cases in the acute stage, and 36% of those in the remission stage. The lupus-like anticoagulant was not much involved, and platelets were the prime figures in the haemostatic abnormalities of lupus, those being the preferred target of direct antibody activities, or possibly of immune complexes as well. Activation of the coagulatory cascade is not uncommonly accompanied by a thrombophilic tendency coupled with signs of consumption, this being the expression of a continuously stimulated haemostatic balance.

Keywords

Systemic lupus erythematosus - Coagulation and fibrinolysis abnormality - Platelet disorders - Disseminated intravascular coagulation

^* A preliminary report of work described here was presented at the Interdisciplinary Congress on Laboratory Diagnosis of Kidney and Urinary Tract Disease, Florence, Italy, November 21-24, 1979

• References

• 1 Doni A, Cioni P. Una rara associazione di anemia emolitica e die anticoagulina anomala in circolo in un caso di lupus eritematoso acut disseminato. Boll Soc Ital Ematol 1958; 6: 82-87
• 2 Exner T, Rickard KA, Kroneberg H. A sensitive test demonstrating lupus anticoagulant and its behavioural patterns. Br J Haematol 1978; 40: 143-151
• 3 Okpara RA, Carabello JA, Day NJ. Spurious prolongation of the actived partial thromboplastin time. Thromb Haemostas 1977; 38: 900-908
• 4 Schleider MA, Nachman RL, Jaffe EA, Coleman M. A clinical study of the lupus anticoagulant. Blood 1976; 48: 409-509
• 5 Conley CL, Harmann RC. A hemorrhagic disorder caused by circulating anticoagulants in patients with disseminated lupus erythematosus. J Clin Invest 1952; 31: 621-622
• 6 Cronberg S, Nilsson IM. Circulating anticoagulant against factors XI and XII together with massive spontaneous platelet aggregation. Scand J Haematol 1973; 10: 309-314
• 7 Gandolfo GM, Afeltra A, Amoroso A, Biancolella F, Ferri GM. Circulating anticoagulant against factor XII and platelet antobodies in systemic lupus erytematosus. Acta Haematol 1977; 57: 135-142
• 8 Regan MG, Lackner H, Karpatkin S. Platelet function and coagulation profile in lupus erythematosus. Studies in 50 patients Ann Intern Med 1974; 81: 462-468
• 9 Karpatkin S, Strick N, Karpaatkin MB, Sisjind GW. Cumulative experience in the detection of antiplatelet antibody in 234 patients with idiopathic thrombocytopenic purpura, systemic lupus erythematosus and other clinical disorders. Am J Med 1972; 52: 776-785
• 10 Bonnin JA, Cohen AK, Hicks ND. Coagulation defects in a case of systemic lupus erythematosus with thrombocytopenia. Br J Haematol 1956; 2: 168-179
• 11 Corrigan JJ, Patterson JH, May N. Incoagulability of the blood in systemic lupus erythematosus. Am J Dis Child 1970; 119: 365-369
• 12 Cohen AS, Canoso JJ. Criteria for the classification of systemic lupus erythematosus - Status. Arthritis Rheum 1972; 150: 540-543
• 13 Fries JF. Demonstration: interim meeting of the American Rheuma-tism Association, San Diego. 1971
• 14 Appel GB, Silva FG, Pirani CL, Meltzer JL, Estes D. Renal involvement in systemic lupus erythematodes (SLE): a study of 56 patients emphazing histologic classification. Medicine 1978; 57: 371-382
• 15 Hay FC, Nicham FJ, Roitt IM. Routine assay for the detection of immune complexes of known immunoglobulin class using solid phase C1q. Clin Exp Immunol 1976; 24: 396-401
• 16 Creighton WD, Lambert PH, Miescher PA. Detection of antibodies and soluble antigen-antibody complexes by precipitation with poly-ethylene glycol. J Immunol 1973; 111: 1219-1229
• 17 Camussi G, Caligaris CappioF, Messina M, Coppo R, Stratta P, Vercellone A. The polymorphonuclear neutrophil (PMN) immunohistological technique: detection of immune complexes bound to the PMN membrane in acute post-streptococcal and lupus nephritis. Clin Nephrol 1980; 14: 280-287
• 18 Gandolfo GM. Diagnostica di laboratorio delle malattie emorragiche. Ed Lombardo, Roma: 1977
• 19 Hellem AJ. The adhesiveness of Human blood platelet in vitro. Scand J Clin Lab Inv 1960; (Suppl. 12) suppl 51
• 20 De Gaetano G, Bottecchia D, Vermylen J. Effect of platelets on clot structuration a thrombelastrographic study. Thromb Res 1973; 3: 425-435
• 21 Steffen C. Results obtained with the antiglobulins consumption test and investigations of autoantibody eluates in immunohematology. J Lab Clin Med 1960; 55: 9
• 22 Fuster V, Kazmier FJ, Cash JD, Bowie EJ W, Owen CA. Assay of platelet factor 4 in plasma. Mayo Clin Proc 1973; 48: 103-106
• 23 Doni A, Resina A, Moggi A, Bono F. II test delle diluizioni seriate di solfato di protamina Aspetti tecnici e applicazione clinica. La Ricerca Clin Lab 1974; 4: 83-103
• 24 Hemker HC, Fekkes N, Hensen A, Schrijver H, Loeliger NA. Quantitation of circulating fibrinogen breakdown products in intravascular clotting. Thrombos Diathes Haemorrh 1966; 20: 227-234
• 25 Brain MC, Dacie JV, Hourihane OB. Microangiopathic haemolytic anaemia: the possible role of vascular lesions in pathogenesis. Br J Haematol 1962; 8: 358-373
• 26 Chohan IS, Vermylen J, Singh I, Bala KrishnanK, Verstraete M. Sodium acetate buffer a diluent of choice in the clop lysis time technique. Thrombos Diathes Haemorrh 1975; 33: 226-229
• 27 Villavicencio L. Our fibrinolytic potential. Surgery 1979; 85: 53-58
• 28 Haverkate F, Brakman P. The fibrin plate assay - some crucial conditions. Thrombos Diathes Haemorrh 1975; 33: 312-313
• 29 Pandolfi M. Histochemistry and assay of plasminogen activator. Rev Eur Etud Clin Biol 1972; 13: 254-260
• 30 Donati MB, Molla A, Michielsen P, Vermylen J. Measurement of urinary fibrinogen related material. Methodologic aspects J Lab Clin Med 1974; 83: 921-936
• 31 Canavese C, Stratta P, Ragni R, Thea A, Vercellone A. The nature of “Fibrinogen” detected by immunfluorescence in renal disease. Nephron 1978; 20: 237-239
• 32 Canavese C, Stratta P, Mangiarotti G, Pacitti A, Giachino G, Nepiolo P, Thea A, Vercellone A. Riduzione dell’attività fibrinolitica tissutale, ematica ed ordinaria: Causa o conseguenza di danno renale. Minerva Nefr 1979; 26: 281-287
• 33 Stratta P, Canavese C, Mangiarotti G, Emanuelli G, Segoloni GP, Oneglia R, Racca M, Vercellone A. Studio della fibrinolisi tissutale nelle glomerulonefriti primitive e secondarie. Minerva Nefr 1980; 27: 295-300
• 34 Bowie EJ W, Thompson JH, Pascuzzi CA, Owen CA. Thrombosis in systemic lupus erythematosus despite circulating anticoagulants. J Lab Clin Med 1963; 62: 416-430
• 35 Mannucd PM, Canciani MT, Mari D, Meucci P. The varied sensitivity of partial thromboplastin and prothrombin time reagents in the demonstration of the lupus-like anticoagulant. Scand J Haematol 1979; 22: 423-432
• 36 Stastny P, Ziff M. Lymphocyte and platelet autoantibody in SLE. Lancet 1971; 12: 1239-1240
• 37 Clark WF, Lewis NL, Cameron JS, Parsons V. Intrarenal platelet consumption in the diffuse proliferative nephritis of systemic lupus erythematosus. Clin Sd Mol Med 1975; 49: 247-252
• 38 Moore A, Ross GD, Nachmann RL. Interaction of platelet membrane receptors with von Willebrand factor, ristocetin, and the Fc region of immunoglobulin G. J Clin Invest 1978; 62: 1053-1060