PP-024 Evaluation of the effectiveness of plasmapheresis in patients with habitual miscarriage and antiphospholipid syndrom

To evaluate the effect of plasmapheresis on the level of antiphospholipid antibodies in women with habitual miscarriage against the background of antiphospholipid syndrome.

The study was carried out on the Center for Family Planning and Reproduction of the Moscow Department of Health, Maternity Hospital №3, Moscow, Russian Federation. The main group included 80 patients diagnosed with "Habitual miscarriage due to the development of antiphospholipid syndrome", who underwent a course of plasmapheresis of 7 procedures. The control group consisted of 70 patients with antiphospholipid syndrome who did not undergo plasmapheresis courses. During pregnancy planning, all patients were prescribed complex therapy aimed at preventing venous thromboembolic complications.
Plasmapheresis was performed using an intermittent technique. Premedication included hormonal drugs and antihistamines. During one procedure, 968.5 ±102.1 ml of blood was extracted, followed by replenishment of at least 80% of the volume with freshly frozen donor plasma and blood substitutes. The extracted blood was centrifuged at a speed of 1500 rpm for 20 minutes in an OS-6M centrifuge, then plasma was removed and erythrocytes were washed three times with isotonic sodium chloride solution in a ratio of 1:1.5. The resulting erythrocyte mass was irradiated with a helium-neon laser on an ALOK-1 apparatus at a dose of (3-3.5)× 0.1 J/ml for 18-22 minutes.
The level of antibodies to phospholipids, cardiolipin, β2-glycoprotein‑1 and β-subunit of human chorionic gonadotropin was determined by enzyme immunoassay using a MultiScan EX analyzer. The level of lupus anticoagulant was determined using an ACL-200 coagulometer (Instrumental Laboratory, Spain).

After plasmapheresis, the detection rate of lupus anticoagulant decreased in the main group by 72.16% (p=0.0001). Before therapy, it was detected in the main group in 25 patients (31.25%), and after that – only in 7 (8.75%), in the control group – in 18 (25.71%).
The detection rate of total antibodies to phospholipids decreased by 62.26% in the main group (p=0.001). Before therapy, total antibodies to phospholipids in the main group were detected in 53 (66.25%) patients, and after that – in 20 (25%), in the control group – in 45 (64.28%) patients.
Antibodies to cardiolipin were detected before treatment in 28 patients (35%) of the main group and 24 patients (34.28%) of the control group, after the course of treatment – in 23 (28.75%). Thus, the frequency of detection of these antibodies decreased in the main group by 17.8% (p=0.47).
Antibodies to β2-glycoprotein‑1 were detected before treatment in 55 patients (68.75%) of the main group and in 50 (711.42%) of the control group. After the course of treatment, antibodies were detected in 17 (21.25%) patients. In general, the detection rate of these antibodies decreased by 69.09% in the main group (p=0.001).
Antibodies to the β-subunit of human chorionic gonadotropin were determined in the main group before treatment in 15 patients (18.75%), after – in 9 (11.25%), in the control group – in 16 (22.85%). During therapy, the frequency of antibody detection decreased by 40% in the main group (p=0.49). These antibodies were verified after treatment only in combination with other markers of antiphospholipid syndrome.

The results of our study demonstrate a statistically significant decrease in the level of antiphospholipid antibodies in the blood of women after plasmapheresis procedures. The greatest effect was observed in relation to antibodies to β2-glycoprotein‑1 and lupus anticoagulant, the least in relation to antibodies to cardiolipin. This method of efferent therapy has immunocorrective, detoxifying effects, improves the rheological properties of blood, which makes it possible to recommend its implementation at the stage of pre-gravidar preparation for women with antiphospholipid syndrome.