1. Autoimmune Disorders During Pregnancy -Lupus -Antiphospholipid syndrome
Rovnat Babazade, MD
Obstetrical Anesthesia-2016

2. SYSTEMIC LUPUS ERYTHEMATOSUS
An extremely complicated and multifactorial interaction among various genetic and environmental factors
The loss of immune tolerance
Increased antigenic load, excess T cell help
Defective B cell suppression
Shifting of T helper 1 (Th1) to Th2 immune responses
Leads to B cell hyperactivity and the production of pathogenic autoantibodies
Finally, certain environmental factors are probably required to trigger the disease

3. SYSTEMIC LUPUS ERYTHEMATOSUS
1997 ACR Classification Criteria
Malar rash
Discoid rash
Photosensitivity
Oral ulcers
Arthritis
Serositis
Renal disorder
Neurologic disorder
Hematologic disorder
Immunologic disorder
Anti-nuclear antibodies

4. SYSTEMIC LUPUS ERYTHEMATOSUS
2012 SLICC Classification Criteria
CLINICAL
Acute cutaneous
Chronic cutaneous
Oral ulcers
Non-scarring alopecia
Synovitis
Serositis
Renal
Neurologic
Hemolytic anemia
Leucopenia / Lymphopenia
Thrombocytopenia
IMMUNOLOGIC
ANA
Anti-dsDNA
Anti-Sm
Anti-Phospholipid
Low complement
Direct Coomb’s test
Petri M et al. Derivation and vallidation of the SLICC Classification Criteria for SLE. Arth & Rheum 2012

5. Clark CA et al. Decrease in pregnancy loss rates in patients with SLE over a 40-year period. J Rheumatol 2005

6. Smyth A et al. A systematic review and metaanalysis of pregnancy outcomes in patients with
SLE and lupus nephritis. Am Soc Nephrol 2010

7. Clark CA et al. Decrease in pregnancy loss rates in patients with SLE over a 40-year period. J Rheumatol 2005

8. Yang H et al. Pregnancy-related SLE: clinical features, outcome and risk factors of disease flares – a case control study. PLoS ONE 2014

9. Flares During Anesthesia/Surgery?
SLE significantly increased
the risks of surgical patients
for overall major complications
and mortality after major surgery.
Lin J-A, et al. Ann Rheum Dis 2014

10. Flares During Anesthesia/Surgery?
Summary of complications among N=141,345 matched discharges
SLE
(N = 28,269)
Control
(N = 113,076)
OR (99% CI)
P-Value
RENAL COMPLICATIONS
584.6 Acute renal failure with cortical (renal)
0 (0.00)
584.7 Acute renal papillary necrosis with medullary (renal) (papillary)
584.5 Acute renal papillary necrosis with tubular
218 (0.77)
623 (0.55)
584.8 Acute renal failure with specified pathology NEC
3 (0.01)
7 (0.01)
584.9 Acute kidney injury (nontraumatic)
768 (2.72)
2,292 (2.03)
997.5 Acute postoperative renal failure
93 (0.33)
393 (0.35)
- Any of the above renal complications -
1,047 (3.70)
3,179 (2.81)
1.33 (1.21, 1.46)
< 0.001
CARDIOVASCULAR COMPLICATIONS
997.1 Cardiac Arrest/insufficiency during or resulting from a procedure
177 (0.63)
830 (0.73)
Acute coronary occlusion without myocardial infarction
2 (0.007)
4 (0.004)
518.4 Pulmonary edema, postoperative
37 (0.13)
112 (0.10)
410 Myocardial infarction
111 (0.39)
403 (0.36)
- Any of the above cardiovascular complications -
304 (1.08)
1,237 (1.09)
0.98 (0.83, 1.16)
0.79
IN-HOSPITAL MORTALITY
454 (1.61)
1,430 (1.26)
1.27 (1.11, 1.47)
SLE was associated with higher risk of renal complications and in-hospital mortality but not cardiac events after major surgery
Babazade et al. The Association between Systemic Lupus Erythematosus and
Adverse Postoperative Outcomes. Anesthesia and Analgesia. 2016

12. Anti-Phospholipid Syndrome (APS)
β2-glycoprotein I (β2GPI)
recognized as a
major target for
autoantibodies in APS
In situ association between β2GPI and HLA class II was observed in placental tissues of APS patients but not in healthy controls

13. Anti-Phospholipid Syndrome (APS)
2–4% in the general population
Raising awareness of antiphospholipid antibody syndrome .The Lancet 2010

14. Anti-Phospholipid Syndrome (APS)
2006-modified Sapporo
Lockshin MD. Anticoagulation in Management of Anti-Phospholipid Antibody Syndrome in Pregnancy. Clin Lab Med 2013

15. Anti-Phospholipid Syndrome (APS)

16. Anti-Phospholipid Syndrome (APS)

17. Anti-Phospholipid Syndrome (APS)

18. Anti-Phospholipid Syndrome (APS)