An Indonesian Woman Pregnancy with Anti-Phospholipid Syndrome and Systemic Lupus Erythematosus: A Case Report
Keywords:
Abortion, antiphospholipid syndrome, pregnancy, systemic lupus erythematosusAbstract
Woman pregnancy with antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) is a rare case. An Indonesian woman pregnancy, 29 years old, complained of right-sided chest pain, cough, short breath, melena, and joint discomfort. She has had two abortions in the past 2 years. The patient previously had anemia with hemoglobin of 5 mg/dL and received 4x PRC transfusions. Echocardiography and chest CT scan with contrast revealed a right ventricle thrombus. Laboratory examination presented with APS and suspected autoimmune hemolytic anemia (AIHA). Patient received PCR transfusion of 250 mL twice daily with initially dexamethasone of 5 mg at admission, lansoprazole of 30 mg twice daily, Sucralfate of 15 mL thrice daily, Methylprednisolone of 8 mg once daily, Hydroxychloroquine 200 mg once daily, Enoxaparin of 0.6 mL twice daily, and acetylsalicylic acid of 80 mg once day. After treatment, she had an improved Hb of 10.3 g/dL and was discharged. Despite clinical improvement, she had a third abortion. The challenge in APS Management is to increase fetal and maternal growth and prevent thrombus formation with close monitoring of anticoagulant use. Patients who experience recurrent abortions need to be considered for APS and/or SLE possibility
Downloads
References
Dalal DS, Patel KA, Patel MA. Systemic Lupus Erythematosus and Pregnancy: A Brief Review. Journal of obstetrics and gynaecology of India. 2019;69(2):104-9. doi: 10.1007/s13224-019-01212-8.
Felani R, Awalia. An Indonesian pregnant woman with systemic lupus erythematosus and cardiac tamponade: A case report. International journal of surgery case reports. 2022;94:107159. doi: 10.1016/j.ijscr.2022.107159.
Hadisuwarno W, Rahmawati LD. An Indonesian female with severe cutaneous lupus erythematosus: A case report and literature review. International journal of surgery case reports. 2023;107:108336. doi: 10.1016/j.ijscr.2023.108336.
Mok CC, Chan PT, Ho LY, Yu KL, To CH. Prevalence of the antiphospholipid syndrome and its effect on survival in 679 Chinese patients with systemic lupus erythematosus: a cohort study. Medicine. 2013;92(4):217-22. doi: 10.1097/MD.0b013e31829cae47.
Branch DW, Lim MY. How I diagnose and treat antiphospholipid syndrome in pregnancy. Blood. 2024;143(9):757-68. doi: 10.1182/blood.2023020727.
Aninnaimah HD, Awalia. Unprovoked upper extremity deep vein trhombosis in patient with primary antiphospholipid syndrome: a case report. Current Internal Medicine Research and Practice Surabaya Journal. 2022;3(2):54-8. doi: 10.20473/cimrj.v3i2.38144.
Tao JJ, Adurty S, D'Angelo D, DeSancho MT. Management and outcomes of women with antiphospholipid syndrome during pregnancy. Journal of thrombosis and thrombolysis. 2023;55(4):751-9. doi: 10.1007/s11239-023-02789-8.
Mathesan M, Ethirajan S. Triumph Over Adversity: A Comprehensive Case Series on Successful Pregnancy Outcomes in Antiphospholipid Antibody (APLA)-Positive Patients. Cureus. 2024;16(4):e59088. doi: 10.7759/cureus.59088.
Capecchi M, Abbattista M, Ciavarella A, Uhr M, Novembrino C, Martinelli I. Anticoagulant Therapy in Patients with Antiphospholipid Syndrome. Journal of clinical medicine. 2022;11(23). doi: 10.3390/jcm11236984.
Nelwan SC, Tedjosasongko U, Dharmawan D, Leo LM, Ardiana HA, Rahmawati S. The Combination of Ultraviolet-B and Vitamin K2 Exposure Effect on Fibroblast-like cell Number in Wistar Rats. Indonesian Journal of Dental Medicine. 2023;6(1):19-23. doi: 10.20473/ijdm.v6i1.2023.19-23.
An J, Bider Z, Luong TQ, Cheetham TC, Lang DT, Fischer H, et al. Long-Term Medication Adherence Trajectories to Direct Oral Anticoagulants and Clinical Outcomes in Patients With Atrial Fibrillation. Journal of the American Heart Association. 2021;10(21):e021601. doi: 10.1161/jaha.121.021601.
Mekinian A, Lazzaroni MG, Kuzenko A, Alijotas-Reig J, Ruffatti A, Levy P, et al. The efficacy of hydroxychloroquine for obstetrical outcome in anti-phospholipid syndrome: Data from a European multicenter retrospective study. Autoimmunity reviews. 2015;14(6):498-502. doi: 10.1016/j.autrev.2015.01.012.
Sciascia S, Hunt BJ, Talavera-Garcia E, Lliso G, Khamashta MA, Cuadrado MJ. The impact of hydroxychloroquine treatment on pregnancy outcome in women with antiphospholipid antibodies. American journal of obstetrics and gynecology. 2016;214(2):273.e1-.e8. doi: 10.1016/j.ajog.2015.09.078.
Liu L, Sun D. Pregnancy outcomes in patients with primary antiphospholipid syndrome: A systematic review and meta-analysis. Medicine. 2019;98(20):e15733. doi: 10.1097/md.0000000000015733.
Lu C, Liu Y, Jiang HL. Aspirin or heparin or both in the treatment of recurrent spontaneous abortion in women with antiphospholipid antibody syndrome: a meta-analysis of randomized controlled trials. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet. 2019;32(8):1299-311. doi: 10.1080/14767058.2017.1404979.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
