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Re: Asymptomatic + ANAFrom: Peter Wein (p.wein@obsgyn-mercy.unimelb.EDU.AU)Sun Mar 15 23:09:49 1998
At 10:55 PM 15/03/98 -0600, you wrote:
>Dear listers:
>
>Got a couple of patients who have a + ANA and no symptoms
whatsoever.
>
>One is a G2 P1 currently in 2nd trimester, with clinically
chronic
>hypertension (numbers are 160-170 sys and 100-110 dia).
There is no
>proteinuria/thrombocytopenia/CNS symptoms.
>For her, what if any further workup would you do? I
planned on doing weekly
>NSTs starting at 28 weeks. Does anyone test for fetal
heart block, rare
>antibodies, etc.? Her ANA titer is 1:80, diffuse
pattern.
>
>Another patient is one of our office staff (permission given to
post her
>case), a 22 year old nulligravida, on DepoProvera, who we found
to have a
>1:80 ANA last year. A repeat titer one year later is
1:320. The report
>said nucleolar pattern both times.
>
>What would be your next step? (please don't say "punt to
the
>rheumatologist")
>
>Thanks for all feedback...
>
>Hugo D. Ribot Jr., M.D., FACOG
>Cartersville, GA
>Private practice in a 2 MD (soon to be a 3 MD) and 2 CNM
group
>
ANA at a titre of 1:80 is practically meaningless by itself - why
did they have the tests performed.
If you are concerned about SLE - need to measure anti_DNA as well,
and specify antiSS DNA for risk of congenital heart block. May also be
worth testing for lupus anticoag and anticardiolipin - but it depends o
the reason the women were tested in the first place. For isolated low
titre plosive ANA - no special treatment necessary.
Senior Lecturer Department of Obstetrics and Gynaecology University of Melbourne, Mercy Hospital for Women Clarendon Street, East Melbourne 3002 Australia Tel: +61 3 9270 2556 Fax: +61 3 9417 5406 Mobile: 0414 691690
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