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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The lupus anticoagulant &#40;LA&#41; are a heterogeneous class of immunoglobulins&#44; antiphospholipid antibodies &#40;aPL&#41;&#44; that interfere with phospholipid-dependent coagulation tests in vitro<span class="elsevierStyleItalic">&#46;</span></p><p id="par0010" class="elsevierStylePara elsevierViewall">Development of LA is associated with several conditions&#44; such as autoimmune diseases&#44; infections&#44; malignancies&#44; or drugs&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> LA can also be found in healthy individuals&#46; The antibody-antigen complexes compete with clotting factors for the phospholipids necessary in clotting assays&#44; prolonging phospholipid-dependent times&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The presence of LA can be related to venous and arterial thrombosis and pregnancy morbidity&#44; causing antiphospholipid syndrome &#40;APS&#41;&#46; However&#44; much less frequently&#44; LA can cause bleeding when associated with hypoprothrombinemia&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Concomitant acute acquired hypoprothrombinemia and LA is known as the lupus anticoagulant-hypoprothrombinemia syndrome &#40;LAHPS&#41;&#44; and is probably a consequence of anti-factor II auto-antibodies development&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">We describe a case of a male adult with APS diagnosis who presented a cerebral bleeding as a SLE debut&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0025" class="elsevierStylePara elsevierViewall">A 42-year-old caucasian man with a medical history of primary APS &#40;3 episodes of deep vein thrombosis and triple positivity for antiphosphopilipid antibodies&#41; diagnosed when he was 15 years old&#44; on chronic anticoagulation with acenocoumarol&#44; with an adequate target therapeutic range &#40;TTR&#41; &#40;75&#37;&#41;&#44; presented at the emergency department complaining about a 15-days intense headache&#44; several episodes of spontaneous self-limited mild epistaxis&#46; He had no family history of hereditary bleeding disorders or autoimmune disease&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Neurological examination was normal&#44; Glasgow Coma Scale 15&#44; and his blood arterial pressure was within normal range&#46; No pathological findings were found in the rest of the patient&#39;s physical examination&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A skull CT scan was performed and revealed a hypodense collection with hyperdense areas at the right parietal subdural level&#46; This was compatible with chronic subdural hematoma with rebleeding areas and large mass effect with ipsilateral ventricular compression and 9<span class="elsevierStyleHsp" style=""></span>mm midline deviation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; With these findings and neurosurgical assessment&#44; treatment started with intravenous dexamethasone 40<span class="elsevierStyleHsp" style=""></span>mg daily was iniciated&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">His complete blood test revealed a white blood cell count &#40;WBC&#41; and platelet count within normal range&#44; whereas hemoglobin was slightly low &#40;11&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;l&#41;&#46; Coagulation tests showed prolonged prothrombin time &#40;PT&#41; &#91;28&#46;7<span class="elsevierStyleHsp" style=""></span>seconds &#40;s&#41;&#93;&#44; INR 2&#46;5&#44; prolonged activated partial thromboplastin time &#40;APTT&#41; &#40;82&#46;5<span class="elsevierStyleHsp" style=""></span>s&#41; and normal derived fibrinogen&#46; Prolongation of APTT was not corrected when mixed with normal pooled plasma &#40;1&#58;1 ratio&#41; &#40;77&#46;3<span class="elsevierStyleHsp" style=""></span>s&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The anticoagulation was reversed with 10<span class="elsevierStyleHsp" style=""></span>mg every 12&#47;24<span class="elsevierStyleHsp" style=""></span>h endovenous vitamin K&#46; Given the life-threatening bleeding suffered by the patient and before a possible emergent surgery a prothrombin complex concentrate &#40;CCP&#41; of 4 factors at a dose &#40;10&#8211;30<span class="elsevierStyleHsp" style=""></span>IU&#47;kg&#41; and plasma &#40;15&#8211;30<span class="elsevierStyleHsp" style=""></span>mL&#47;kg body weight&#41; achieving an INR of 1&#46;75&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Since the patient remained clinically stable through the next hours&#44; urgent surgery was dismissed&#44; unless neurological worsening&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The same results were observed in a repeated basic coagulation study&#59; thus an extended coagulation profile was performed in the next days&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Given the suspicion of the existence of an inhibitor of the coagulation factors&#44; corticotherapy was continued with prednisone a dose of 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg-weight per day&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A strong positive LA was detected&#44; with diluted Russell Viper Venom Time &#40;dRVVT&#41; and Silica Clotting Time &#40;SCT&#41; normalized ratios of 3&#46;3 and 2&#46;8 respectively&#46; Positivity for anti-Cardiolipin &#40;Ig G 164 GPL&#59; Ig M 143 MPL&#41;&#44; anti-&#946;2-Glycoprotein I &#40;anti-&#946;2GPI&#41; &#40;Ig G&#58; 176&#46;77<span class="elsevierStyleHsp" style=""></span>U&#47;ml&#59; Ig M&#58; 130<span class="elsevierStyleHsp" style=""></span>U&#47;ml&#41; and anti-Prothrombin &#40;anti-PT&#41; was also detected&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Low levels of factor II &#40;12&#37;&#41; were observed&#46; Increasing dilutions with normal pooled plasma showed persistently decreased factor II levels&#44; even at a 1&#47;100 dilution&#46; Decreased levels of factor VIII &#40;40&#37;&#41;&#44; factor IX &#40;20&#37;&#41;&#44; factor XI &#40;12&#37;&#41; and factor XII &#40;16&#37;&#41; were observed&#44; with normalization of their levels when patient plasma was tested in higher dilutions&#46; These findings were compatible with an in vitro non-specific inhibition effect of LA against intrinsic pathway factors&#46; The intensity of ACL did not vary in the successive determinations&#44; and neither did its inhibitory effect against intrinsic pathway factors&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The dilutions were made on several occasions at the beginning of the episode&#46; Subsequently&#44; after starting treatment&#44; with the progressive increase to the normalization of the factor and the good clinical evolution&#44; no additional study of factor II dilutions were made&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Positivity for antinuclear antibodies &#40;1&#47;80 without other specificity&#41; and hypocomplementemia &#91;C3&#58; 70<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;normal range 90&#8211;170&#41;&#59; C4&#58; 3<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;normal range 12&#8211;36&#41; were also observed&#46; Direct Coombs was positive&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In addition to headache&#44; during hospitalization in the next weeks&#44; he referred generalized arthralgias and a striking malar erythema was observed for the first time&#46; With the results obtained from the complementary tests and with the suspicion of autoimmune disease&#44; an interconsultation requests from the rheumatology department&#44; who&#44; after adequate anamnesis of the patient&#44; the diagnosis of SLE was concluded&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">LAHPS&#44; debut of SLE and thrombotic APS were the final diagnosis&#46; Treatment was initiated with prednisone at a dose of 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg once daily&#44; hydroxicloroquine 200<span class="elsevierStyleHsp" style=""></span>mg every 12<span class="elsevierStyleHsp" style=""></span>hours&#44; non-specific human immunoglobulins at a dose of 0&#46;4<span class="elsevierStyleHsp" style=""></span>g&#47;kg for 5 days and Anti-CD20 at a dose of 1<span class="elsevierStyleHsp" style=""></span>g every 15 days &#40;2 doses&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">He remained asymptomatic from the neurological point of view&#44; with progressive hematoma resolution and factor II levels improvement &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; He received appropriate antithrombotic therapy with low molecular weight heparin &#40;LMWH&#41; at prophylactic dose &#40;enoxaparin 40<span class="elsevierStyleHsp" style=""></span>mg once daily&#41;&#44; with progressive dose increase as the hematoma and the factor II levels improved &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">After 2 weeks hospitalizated&#44; the patient initiated outpatient follow-up in rheumatology and hematology&#46; He has presented several SLE outbreaks consisting on arthralgia&#44; asthenia and headache&#44; but no bleeding episode has occurred and his factor II levels have remained normal&#46; As an antithrombotic treatment&#44; secondary prophylaxis with enoxaparin at a dose of 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg once daily during the first three months was prescribed with adequate compliance&#44; increasing the dose until therapeutic level after the brain hemorrhage was completely resolved&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">Clotting factor II&#44; or prothrombin&#44; is a vitamin K-dependent coagulation cofactor that is cleaved by factor Xa to form thrombin&#44; therefore inducing platelet aggregation and coagulation cascade activation&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Inherited factor II deficiency is uncommon&#44; whereas acquired deficiency is a frequent finding in severe liver disease&#44; vitamin K deficiency&#44; or vitamin K antagonist treatment&#46; Commonly&#44; in these situations other coagulation factors are also decreased&#44; such as factors VII and X&#44; and factor V in some cases&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The isolated acquired factor II deficiency can occasionally be observed in patients with LA&#44; a laboratory interference produced by antiphospholipid antibodies&#46; This association is known as LAHPS&#44; a rare syndrome that normally has been reported to be related to certain situations such as primary APS&#44; infections&#44; and occasionally drugs&#44; but mostly to LES&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The existence of Anti-prothrombin antibodies has been proven&#46; Anti-prothrombin are non-neutralizing antibodies directed against the inactive sites of prothrombin &#40;i&#46;e&#46;&#44; prothrombin I and &#945;-thrombin&#41; and therefore do not cause immediate inhibition&#46; Different published studies suggest an increased clearance of Factor II from circulation&#44; leading to its deficiency&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The incidence of acquired hypoprothrombinemia associated with LA appears to be higher in the paediatric age group&#44; since 55&#37; of reported cases &#40;49 of 89&#41; were diagnosed in patients under the age of 16&#44; with a median age at disease onset of 13 years &#40;range 1&#8211;86 years&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;6&#8211;8</span></a> This may be explained by the naturally faster hepatic clearance of the prothrombin&#47;prothrombin antibody complex in children compared to adults&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Women are more affected than men&#44; with an overall female&#58; male ratio of 1&#46;5&#58;1 &#40;54 women and 35 men&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">An underlying pathology can be identified&#44; such as an autoimmune disease &#40;most likely SLE&#41;&#44; viral o bacterial infection&#44; the most common underlying disease in paediatric population&#46; There are few reported cases associated with malignancy &#40;e&#46;g&#46; lymphoma and multiple myeloma&#41; almost exclusively in adults or drugs &#40;phenytoin or quinidine&#41;&#46; In around 10&#37; of cases&#44; no underlying illness is evident&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4&#44;9&#44;10</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">In most cases the initial symptom is bleeding&#44; which can vary between minor bleeding&#44; like epistaxis&#44; ecchymoses&#44; gingival bleeding&#44; petechiae&#44; to severe haemorrhagic symptoms such as gynecologic bleeding&#44; macroscopic hematuria&#44; digestive tract hemorrhage&#44; intracerebral hematoma&#44; and&#47;or intramuscular hematoma&#46; Bleeding can appear spontaneously or after trauma or surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4</span></a> On the other hand&#44; arterial or venous thromboses as well as pregnancy morbidity are frequent in patients who have LA associated to SLE or APS&#46; These thrombotic events are described in patients with LAHPS and autoimmune disease&#44; but not with infections&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;9</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">In our patient with an intracraneal bleeding&#44; the initial suspicious was cause of the oral anticoagulant &#40;OAC&#41;&#46; Cerebral hemorrhage is the most serious complication of anticoagulant therapy&#46; Of all intracranial hemorrhages&#44; between 10 and 25&#37; occur in patients receiving oral anticoagulant therapy with vitamin K antagonists&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Hemorrhagic strokes are rare in young adults and most often attributable to vascular anomalies or bleeding diathesis&#46; While ischemic infarcts are a more typical complication of antiphospholipid antibody syndrome&#44; bleeding can be associated with thrombocytopenia&#44; acquired factor VIII inhibitors&#44; or hypothrombinemia through the presence of anti-prothrombin antibodies&#46; Antibodies to prothrombin most likely cause bleeding by accelerating the clearance of antibody&#8212;antigen complexes from the circulation&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">We had to suspect LAHPS when we found a prolongation of PT and APTT in a patient with LA&#44; in the absence of sepsis or disseminated intravascular coagulation &#40;DIC&#41;&#44; facing the failed reversal of coagulation with the appropriate measures&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The other laboratory findings are a normal TT&#44; &#64257;brinogen and normal platelet count&#46; A mixing study of patient plasma with normal pooled plasma in a ratio of 1&#58;1&#44; can distinguish between a factor deficiency &#40;normalized APTT and PT&#41; in contrast to LAHPS &#40;only PT will get normalized after mixing&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> A factor II dosage and anti-prothrombin antibodies complete the diagnostic studies&#46; Apart from the vit K dependent factors&#44; the factors of the intrinsic pathway are decreased by the effect of the lupus anticoagulant&#44; demonstrating normalization with a dilution&#47;parallelism study&#44; so that specific inhibitors directed against these factors were not suspected&#46; When LAHPS patients occasionally show reduced FVIII activity and bleeding tendency Is important to differentiate from acquired hemophilia A &#40;AHA&#41; because these are false findings caused by the influence of LA on clotting time&#46; For differential diagnosis&#44; a reported method for measuring factor VIII activity using diluted patient plasma is relatively effective&#46; Dilution of the sample attenuates the influence of LA on in vitro clotting time&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">As first line treatment&#44; corticosteroids at a dose of 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg once daily are recommended&#44; alone or in combination with other immunosuppressant agents &#40;azathioprine&#44; cyclophosphamide&#44; mycophenolate mofetil&#44; immunoglobulins or rituximab&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">In case of severe bleeding&#44; supportive care with plasma&#44; vitamin K&#44; prothrombin complex concentrate or recombinant factor VII can be used&#44; as well as red blood cells and platelet transfusions&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Special attention should be paid to thrombosis&#44; which can be present when factor II levels normalize&#46; Thus&#44; in these cases&#44; anticoagulation or an antiplatelet agent after initial stabilization is recommended&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;9</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0175" class="elsevierStylePara elsevierViewall">This case highlights the importance of taking into account the possibility of LAHPS in any patient with LA&#44; regardless of his&#47;her age&#44; with prolonged TP and APTT and bleeding history&#46; Although in our patient the hypothesis about the origin of bleeding was more in favor of an adverse effect of oral anticoagulation&#44; an early diagnosis of this clinical entity and a quick initiation of immunosuppressive treatment&#44; as well as a diagnosis of the underlying disease determines patient&#39;s clinical development&#46; The therapeutic challenge was to delay the urgent surgical option since it could have entailed a high risk of bleeding and therefore a fatal outcome for the patient&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Funding</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors did not receive support from any organization for the submitted work&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Consent to publication</span><p id="par0185" class="elsevierStylePara elsevierViewall">For the presentation of this case report&#44; informed consent was obtained from the patient&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of interest</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            2 => "Lupus eritematoso sist&#233;mico"
            3 => "Adulto"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lupus anticoagulant-hypoprothrombinaemia syndrome &#40;LAHPS&#41; is a rare disorder caused by the presence of lupus anticoagulant &#40;LA&#41; and acquired prothrombin deficiency&#44; which may present with severe haemorrhagic manifestations&#46; LAHPS is usually associated with systemic lupus erythematosus &#40;SLE&#41;&#44; or infections and it is more frequent in the paediatric population and female gender&#46; We describe a 42-year-old man with thrombotic antiphospholipid syndrome &#40;APS&#41; on chronic anticoagulation treatment with acenocoumarol who presented with spontaneous intracranial bleeding&#44; prolongation of prothrombin time &#40;PT&#41;&#44; activated partial thromboplastin time &#40;APTT&#41; and low factor II levels &#40;after optimal anticoagulation reversal&#41; as a debut of SLE&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El s&#237;ndrome de anticoagulante l&#250;pico-hipoprotrombinemia &#40;LAHPS&#44; por sus siglas en ingl&#233;s&#41; es un trastorno raro&#44; causado por la presencia de anticoagulante l&#250;pico &#40;AL&#41; y deficiencia adquirida de protrombina&#44; que puede cursar con manifestaciones hemorr&#225;gicas graves&#46; El LAHPS suele asociarse a lupus eritematoso sist&#233;mico &#40;LES&#41; o infecciones&#44; y es m&#225;s frecuente en poblaci&#243;n pedi&#225;trica y en el g&#233;nero femenino&#46; Describimos a un var&#243;n de 42 a&#241;os con s&#237;ndrome antifosfol&#237;pido &#40;SAF&#41; tromb&#243;tico en tratamiento anticoagulante cr&#243;nico con acenocumarol que present&#243; sangrado intracraneal espont&#225;neo&#44; prolongaci&#243;n tanto del tiempo de protrombina &#40;TP&#41; como del tiempo de tromboplastina parcial activada &#40;TTPA&#41; y factor bajo de nivel II &#40;despu&#233;s de la reversi&#243;n &#243;ptima de la anticoagulaci&#243;n&#41; como inicio de LES&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Platelet&#47;L&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">152<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">150&#8211;450<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Hb &#40;g&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&#8211;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">PT &#40;s&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">28&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10&#8211;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">PT after mixing 15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">APTT &#40;s&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">82&#46;5</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">26&#8211;36</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">APTT after mixing 75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fibrinogen &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">318&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">200&#8211;400&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Factor II &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#8211;120</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factor V &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factor VII &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factor X &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factor VIII &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factor IX &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factor XI &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factor XII &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Results of the coagulation studies on admission&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Prothrombin time &#40;PT&#41;&#59; activated partial thromboplastin time &#40;APTT&#41;&#59; antibody to prothrombin &#40;ACs anti-PT&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Laboratory&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Normal range&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">On admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2 months after&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">12 months after&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">PT &#40;s&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#8211;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">T&#46; mixes PT</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">aPTT &#40;s&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#8211;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">aPTT &#40;s&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Factor II assay &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#8211;120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Lupus anticoagulant</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">drVVT normalized ratio</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">SCT normalized ratio</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Anticardiolipin antibody &#40;GPL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IgG</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">164&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">174&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">IgM</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">143&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">47&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Anti &#946;2 GPI antibody &#40;U&#47;ml&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">176&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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Vol. 19. Núm. 4.
Páginas 223-227 (abril 2023)
Case report
Lupus anticoagulant-hypoprothrombinemia syndrome: A cerebral bleeding case report as systemic lupus erythematosus debut
Síndrome anticoagulante lúpico-hipoprotrombinemia: caso clínico de hemorragia cerebral como inicio de lupus eritematoso sistémico
Miriam Lopez Pérez
Autor para correspondencia
, Rosa Vidal Laso, Diego Velasco-Rodríguez, Sara Martín-Herrero, Inés Martinez Alfonzo, Aránzazu García-Raso, Pilar Llamas-Sillero
Department of Hematology, Hospital Universitario Fundación Jiménez Díaz, Hospitales Quirón Públicos, IIS-FJD, Madrid, Spain

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Case report
Lupus anticoagulant-hypoprothrombinemia syndrome: A cerebral bleeding case report as systemic lupus erythematosus debut
Síndrome anticoagulante lúpico-hipoprotrombinemia: caso clínico de hemorragia cerebral como inicio de lupus eritematoso sistémico
Miriam Lopez Pérez
Autor para correspondencia
, Rosa Vidal Laso, Diego Velasco-Rodríguez, Sara Martín-Herrero, Inés Martinez Alfonzo, Aránzazu García-Raso, Pilar Llamas-Sillero
Department of Hematology, Hospital Universitario Fundación Jiménez Díaz, Hospitales Quirón Públicos, IIS-FJD, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The lupus anticoagulant &#40;LA&#41; are a heterogeneous class of immunoglobulins&#44; antiphospholipid antibodies &#40;aPL&#41;&#44; that interfere with phospholipid-dependent coagulation tests in vitro<span class="elsevierStyleItalic">&#46;</span></p><p id="par0010" class="elsevierStylePara elsevierViewall">Development of LA is associated with several conditions&#44; such as autoimmune diseases&#44; infections&#44; malignancies&#44; or drugs&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> LA can also be found in healthy individuals&#46; The antibody-antigen complexes compete with clotting factors for the phospholipids necessary in clotting assays&#44; prolonging phospholipid-dependent times&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The presence of LA can be related to venous and arterial thrombosis and pregnancy morbidity&#44; 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diagnosed when he was 15 years old&#44; on chronic anticoagulation with acenocoumarol&#44; with an adequate target therapeutic range &#40;TTR&#41; &#40;75&#37;&#41;&#44; presented at the emergency department complaining about a 15-days intense headache&#44; several episodes of spontaneous self-limited mild epistaxis&#46; He had no family history of hereditary bleeding disorders or autoimmune disease&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Neurological examination was normal&#44; Glasgow Coma Scale 15&#44; and his blood arterial pressure was within normal range&#46; No pathological findings were found in the rest of the patient&#39;s physical examination&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A skull CT scan was performed and revealed a hypodense collection with hyperdense areas at the right parietal subdural level&#46; This was compatible with chronic subdural hematoma with rebleeding areas and large mass effect with ipsilateral ventricular compression and 9<span class="elsevierStyleHsp" style=""></span>mm midline deviation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; With these findings and neurosurgical assessment&#44; treatment started with intravenous dexamethasone 40<span class="elsevierStyleHsp" style=""></span>mg daily was iniciated&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">His complete blood test revealed a white blood cell count &#40;WBC&#41; and platelet count within normal range&#44; whereas hemoglobin was slightly low &#40;11&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;l&#41;&#46; Coagulation tests showed prolonged prothrombin time &#40;PT&#41; &#91;28&#46;7<span class="elsevierStyleHsp" style=""></span>seconds &#40;s&#41;&#93;&#44; INR 2&#46;5&#44; prolonged activated partial thromboplastin time &#40;APTT&#41; &#40;82&#46;5<span class="elsevierStyleHsp" style=""></span>s&#41; and normal derived fibrinogen&#46; Prolongation of APTT was not corrected when mixed with normal pooled plasma &#40;1&#58;1 ratio&#41; &#40;77&#46;3<span class="elsevierStyleHsp" style=""></span>s&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The anticoagulation was reversed with 10<span class="elsevierStyleHsp" style=""></span>mg every 12&#47;24<span class="elsevierStyleHsp" style=""></span>h endovenous vitamin K&#46; Given the life-threatening bleeding suffered by the patient and before a possible emergent surgery a prothrombin complex concentrate &#40;CCP&#41; of 4 factors at a dose &#40;10&#8211;30<span class="elsevierStyleHsp" style=""></span>IU&#47;kg&#41; and plasma &#40;15&#8211;30<span class="elsevierStyleHsp" style=""></span>mL&#47;kg body weight&#41; achieving an INR of 1&#46;75&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Since the patient remained clinically stable through the next hours&#44; urgent surgery was dismissed&#44; unless neurological worsening&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The same results were observed in a repeated basic coagulation study&#59; thus an extended coagulation profile was performed in the next days&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Given the suspicion of the existence of an inhibitor of the coagulation factors&#44; corticotherapy was continued with prednisone a dose of 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg-weight per day&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A strong positive LA was detected&#44; with diluted Russell Viper Venom Time &#40;dRVVT&#41; and Silica Clotting Time &#40;SCT&#41; normalized ratios of 3&#46;3 and 2&#46;8 respectively&#46; Positivity for anti-Cardiolipin &#40;Ig G 164 GPL&#59; Ig M 143 MPL&#41;&#44; anti-&#946;2-Glycoprotein I &#40;anti-&#946;2GPI&#41; &#40;Ig G&#58; 176&#46;77<span class="elsevierStyleHsp" style=""></span>U&#47;ml&#59; Ig M&#58; 130<span class="elsevierStyleHsp" style=""></span>U&#47;ml&#41; and anti-Prothrombin &#40;anti-PT&#41; was also detected&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Low levels of factor II &#40;12&#37;&#41; were observed&#46; Increasing dilutions with normal pooled plasma showed persistently decreased factor II levels&#44; even at a 1&#47;100 dilution&#46; Decreased levels of factor VIII &#40;40&#37;&#41;&#44; factor IX &#40;20&#37;&#41;&#44; factor XI &#40;12&#37;&#41; and factor XII &#40;16&#37;&#41; were observed&#44; with normalization of their levels when patient plasma was tested in higher dilutions&#46; These findings were compatible with an in vitro non-specific inhibition effect of LA against intrinsic pathway factors&#46; The intensity of ACL did not vary in the successive determinations&#44; and neither did its inhibitory effect against intrinsic pathway factors&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The dilutions were made on several occasions at the beginning of the episode&#46; Subsequently&#44; after starting treatment&#44; with the progressive increase to the normalization of the factor and the good clinical evolution&#44; no additional study of factor II dilutions were made&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Positivity for antinuclear antibodies &#40;1&#47;80 without other specificity&#41; and hypocomplementemia &#91;C3&#58; 70<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;normal range 90&#8211;170&#41;&#59; C4&#58; 3<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;normal range 12&#8211;36&#41; were also observed&#46; Direct Coombs was positive&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In addition to headache&#44; during hospitalization in the next weeks&#44; he referred generalized arthralgias and a striking malar erythema was observed for the first time&#46; With the results obtained from the complementary tests and with the suspicion of autoimmune disease&#44; an interconsultation requests from the rheumatology department&#44; who&#44; after adequate anamnesis of the patient&#44; the diagnosis of SLE was concluded&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">LAHPS&#44; debut of SLE and thrombotic APS were the final diagnosis&#46; Treatment was initiated with prednisone at a dose of 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg once daily&#44; hydroxicloroquine 200<span class="elsevierStyleHsp" style=""></span>mg every 12<span class="elsevierStyleHsp" style=""></span>hours&#44; non-specific human immunoglobulins at a dose of 0&#46;4<span class="elsevierStyleHsp" style=""></span>g&#47;kg for 5 days and Anti-CD20 at a dose of 1<span class="elsevierStyleHsp" style=""></span>g every 15 days &#40;2 doses&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">He remained asymptomatic from the neurological point of view&#44; with progressive hematoma resolution and factor II levels improvement &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; He received appropriate antithrombotic therapy with low molecular weight heparin &#40;LMWH&#41; at prophylactic dose &#40;enoxaparin 40<span class="elsevierStyleHsp" style=""></span>mg once daily&#41;&#44; with progressive dose increase as the hematoma and the factor II levels improved &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">After 2 weeks hospitalizated&#44; the patient initiated outpatient follow-up in rheumatology and hematology&#46; He has presented several SLE outbreaks consisting on arthralgia&#44; asthenia and headache&#44; but no bleeding episode has occurred and his factor II levels have remained normal&#46; As an antithrombotic treatment&#44; secondary prophylaxis with enoxaparin at a dose of 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg once daily during the first three months was prescribed with adequate compliance&#44; increasing the dose until therapeutic level after the brain hemorrhage was completely resolved&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">Clotting factor II&#44; or prothrombin&#44; is a vitamin K-dependent coagulation cofactor that is cleaved by factor Xa to form thrombin&#44; therefore inducing platelet aggregation and coagulation cascade activation&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Inherited factor II deficiency is uncommon&#44; whereas acquired deficiency is a frequent finding in severe liver disease&#44; vitamin K deficiency&#44; or vitamin K antagonist treatment&#46; Commonly&#44; in these situations other coagulation factors are also decreased&#44; such as factors VII and X&#44; and factor V in some cases&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The isolated acquired factor II deficiency can occasionally be observed in patients with LA&#44; a laboratory interference produced by antiphospholipid antibodies&#46; This association is known as LAHPS&#44; a rare syndrome that normally has been reported to be related to certain situations such as primary APS&#44; infections&#44; and occasionally drugs&#44; but mostly to LES&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The existence of Anti-prothrombin antibodies has been proven&#46; Anti-prothrombin are non-neutralizing antibodies directed against the inactive sites of prothrombin &#40;i&#46;e&#46;&#44; prothrombin I and &#945;-thrombin&#41; and therefore do not cause immediate inhibition&#46; Different published studies suggest an increased clearance of Factor II from circulation&#44; leading to its deficiency&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The incidence of acquired hypoprothrombinemia associated with LA appears to be higher in the paediatric age group&#44; since 55&#37; of reported cases &#40;49 of 89&#41; were diagnosed in patients under the age of 16&#44; with a median age at disease onset of 13 years &#40;range 1&#8211;86 years&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;6&#8211;8</span></a> This may be explained by the naturally faster hepatic clearance of the prothrombin&#47;prothrombin antibody complex in children compared to adults&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Women are more affected than men&#44; with an overall female&#58; male ratio of 1&#46;5&#58;1 &#40;54 women and 35 men&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">An underlying pathology can be identified&#44; such as an autoimmune disease &#40;most likely SLE&#41;&#44; viral o bacterial infection&#44; the most common underlying disease in paediatric population&#46; There are few reported cases associated with malignancy &#40;e&#46;g&#46; lymphoma and multiple myeloma&#41; almost exclusively in adults or drugs &#40;phenytoin or quinidine&#41;&#46; In around 10&#37; of cases&#44; no underlying illness is evident&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4&#44;9&#44;10</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">In most cases the initial symptom is bleeding&#44; which can vary between minor bleeding&#44; like epistaxis&#44; ecchymoses&#44; gingival bleeding&#44; petechiae&#44; to severe haemorrhagic symptoms such as gynecologic bleeding&#44; macroscopic hematuria&#44; digestive tract hemorrhage&#44; intracerebral hematoma&#44; and&#47;or intramuscular hematoma&#46; Bleeding can appear spontaneously or after trauma or surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4</span></a> On the other hand&#44; arterial or venous thromboses as well as pregnancy morbidity are frequent in patients who have LA associated to SLE or APS&#46; These thrombotic events are described in patients with LAHPS and autoimmune disease&#44; but not with infections&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;9</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">In our patient with an intracraneal bleeding&#44; the initial suspicious was cause of the oral anticoagulant &#40;OAC&#41;&#46; Cerebral hemorrhage is the most serious complication of anticoagulant therapy&#46; Of all intracranial hemorrhages&#44; between 10 and 25&#37; occur in patients receiving oral anticoagulant therapy with vitamin K antagonists&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Hemorrhagic strokes are rare in young adults and most often attributable to vascular anomalies or bleeding diathesis&#46; While ischemic infarcts are a more typical complication of antiphospholipid antibody syndrome&#44; bleeding can be associated with thrombocytopenia&#44; acquired factor VIII inhibitors&#44; or hypothrombinemia through the presence of anti-prothrombin antibodies&#46; Antibodies to prothrombin most likely cause bleeding by accelerating the clearance of antibody&#8212;antigen complexes from the circulation&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">We had to suspect LAHPS when we found a prolongation of PT and APTT in a patient with LA&#44; in the absence of sepsis or disseminated intravascular coagulation &#40;DIC&#41;&#44; facing the failed reversal of coagulation with the appropriate measures&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The other laboratory findings are a normal TT&#44; &#64257;brinogen and normal platelet count&#46; A mixing study of patient plasma with normal pooled plasma in a ratio of 1&#58;1&#44; can distinguish between a factor deficiency &#40;normalized APTT and PT&#41; in contrast to LAHPS &#40;only PT will get normalized after mixing&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> A factor II dosage and anti-prothrombin antibodies complete the diagnostic studies&#46; Apart from the vit K dependent factors&#44; the factors of the intrinsic pathway are decreased by the effect of the lupus anticoagulant&#44; demonstrating normalization with a dilution&#47;parallelism study&#44; so that specific inhibitors directed against these factors were not suspected&#46; When LAHPS patients occasionally show reduced FVIII activity and bleeding tendency Is important to differentiate from acquired hemophilia A &#40;AHA&#41; because these are false findings caused by the influence of LA on clotting time&#46; For differential diagnosis&#44; a reported method for measuring factor VIII activity using diluted patient plasma is relatively effective&#46; Dilution of the sample attenuates the influence of LA on in vitro clotting time&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">As first line treatment&#44; corticosteroids at a dose of 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg once daily are recommended&#44; alone or in combination with other immunosuppressant agents &#40;azathioprine&#44; cyclophosphamide&#44; mycophenolate mofetil&#44; immunoglobulins or rituximab&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">In case of severe bleeding&#44; supportive care with plasma&#44; vitamin K&#44; prothrombin complex concentrate or recombinant factor VII can be used&#44; as well as red blood cells and platelet transfusions&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Special attention should be paid to thrombosis&#44; which can be present when factor II levels normalize&#46; Thus&#44; in these cases&#44; anticoagulation or an antiplatelet agent after initial stabilization is recommended&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;9</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0175" class="elsevierStylePara elsevierViewall">This case highlights the importance of taking into account the possibility of LAHPS in any patient with LA&#44; regardless of his&#47;her age&#44; with prolonged TP and APTT and bleeding history&#46; Although in our patient the hypothesis about the origin of bleeding was more in favor of an adverse effect of oral anticoagulation&#44; an early diagnosis of this clinical entity and a quick initiation of immunosuppressive treatment&#44; as well as a diagnosis of the underlying disease determines patient&#39;s clinical development&#46; The therapeutic challenge was to delay the urgent surgical option since it could have entailed a high risk of bleeding and therefore a fatal outcome for the patient&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Funding</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors did not receive support from any organization for the submitted work&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Consent to publication</span><p id="par0185" class="elsevierStylePara elsevierViewall">For the presentation of this case report&#44; informed consent was obtained from the patient&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of interest</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lupus anticoagulant-hypoprothrombinaemia syndrome &#40;LAHPS&#41; is a rare disorder caused by the presence of lupus anticoagulant &#40;LA&#41; and acquired prothrombin deficiency&#44; which may present with severe haemorrhagic manifestations&#46; LAHPS is usually associated with systemic lupus erythematosus &#40;SLE&#41;&#44; or infections and it is more frequent in the paediatric population and female gender&#46; We describe a 42-year-old man with thrombotic antiphospholipid syndrome &#40;APS&#41; on chronic anticoagulation treatment with acenocoumarol who presented with spontaneous intracranial bleeding&#44; prolongation of prothrombin time &#40;PT&#41;&#44; activated partial thromboplastin time &#40;APTT&#41; and low factor II levels &#40;after optimal anticoagulation reversal&#41; as a debut of SLE&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El s&#237;ndrome de anticoagulante l&#250;pico-hipoprotrombinemia &#40;LAHPS&#44; por sus siglas en ingl&#233;s&#41; es un trastorno raro&#44; causado por la presencia de anticoagulante l&#250;pico &#40;AL&#41; y deficiencia adquirida de protrombina&#44; que puede cursar con manifestaciones hemorr&#225;gicas graves&#46; El LAHPS suele asociarse a lupus eritematoso sist&#233;mico &#40;LES&#41; o infecciones&#44; y es m&#225;s frecuente en poblaci&#243;n pedi&#225;trica y en el g&#233;nero femenino&#46; Describimos a un var&#243;n de 42 a&#241;os con s&#237;ndrome antifosfol&#237;pido &#40;SAF&#41; tromb&#243;tico en tratamiento anticoagulante cr&#243;nico con acenocumarol que present&#243; sangrado intracraneal espont&#225;neo&#44; prolongaci&#243;n tanto del tiempo de protrombina &#40;TP&#41; como del tiempo de tromboplastina parcial activada &#40;TTPA&#41; y factor bajo de nivel II &#40;despu&#233;s de la reversi&#243;n &#243;ptima de la anticoagulaci&#243;n&#41; como inicio de LES&#46;</p></span>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">150&#8211;450<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hb &#40;g&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#8211;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PT &#40;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#8211;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PT after mixing 15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">APTT &#40;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#46;5</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#8211;36</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">APTT after mixing 75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fibrinogen &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">318&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">200&#8211;400&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factor II &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#8211;120</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factor V &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factor VII &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factor X &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factor VIII &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factor IX &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factor XI &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factor XII &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Results of the coagulation studies on admission&#46;</p>"
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
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            "rol" => "short"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Prothrombin time &#40;PT&#41;&#59; activated partial thromboplastin time &#40;APTT&#41;&#59; antibody to prothrombin &#40;ACs anti-PT&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Laboratory&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Normal range&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">On admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2 months after&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">12 months after&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">PT &#40;s&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#8211;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">T&#46; mixes PT</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">aPTT &#40;s&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#8211;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">aPTT &#40;s&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Factor II assay &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#8211;120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Lupus anticoagulant</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">drVVT normalized ratio</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">SCT normalized ratio</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Anticardiolipin antibody &#40;GPL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IgG</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">164&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">174&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IgM</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">143&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Anti &#946;2 GPI antibody &#40;U&#47;ml&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IgG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">176&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">184&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">156&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IgM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">130&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ACs anti-PT IgG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No tested</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No tested</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ACs anti-PT IgM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Clinical significance of lupus anticoagulants in children"
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                            0 => "C&#46; Male"
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                            2 => "S&#46; Eichinger"
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                            4 => "S&#46; Kapiotis"
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