Modern metods for laboratory detection of lupus anticoagulant in patients with antiphospholipid syndrome
- State institution «Institute of blood pathology and transfusion medicine of the National Academy of Medical Sciences of Ukraine», Lviv
Summary. Aim — to research the informational content for antiphospholipid syndrome (APS) diagnostics of routine coagulogical and modern methods of lupus anticoagulant (LA) detection in patients with thrombosis and pregnancy complications. Object and methods. Routine coagulogical research and аntiphospholipid antibodies identification, including LA, were carried out in 233 patients with the suspicion of APS with thrombosis in different locations and obstetrical pathologies. Results. According to the international criteria of diagnostics 44.6% patients were diagnosed with APS, among which primary APS — in 85.6% and secondary — in 14.4%. LA was identified in 42.5% patients, which is 95.2% of all patients with APS. While carrying out the routine research of haemostasis system, LA can be detected with the help of prolonged prothrombin time and activated partial thromboplastin time (APTT). On the I screening stage of LA detection the most detailed informational value appears while combining the tests based on differential principals and responsible for various parts of haemostasis, in particular the clotting time with phospholipid dependent diluted viper venom time, APTT with LA-sensitive reagent and prothrombin time with diluted to 50 and 500 times thromboplastin. Conclusions. The correctional tests results are not dependable and do not allow to make a decision as to continuation or termination of the further research. The necessity of their execution should be considered individually. Due to the high informational value, confirmation tests should be carried out on the second stage of LA detection. The obtained results are according to the latest 2014 guidelines, which can be used as standards in LA activity research.
Key words: lupus anticoagulant, antiphospholipid antibodies, antiphospholipid syndrome, diagnosis.
- Akkawat B., Rojnuckarin P. (2014) A modified mixing test with a proposed cutoff value to screen for cotting factor inhibitors. J. Hematol. Transfus. Med., 24: 137–143.
- Chandler J.B., Torres R., Rinder H.M. (2014) Lupus anticoagulant testing and anticoagulation do not mix: quantitation of discrepant results and potential approaches to reduce false positives. Br. J. Haematol., 167: 697–726.
- Clinical and Laboratory Standards Institute (CLSI) (2014) Laboratory testing for the lupus anticoagulant: approved guideline. Wayne, USA, 94 р.
- de Groot P., Derksen R. (2005) Pathophysiology of the antiphospholipid syndrome. J. Thromb. Haemost., 3: 1854–1860.
- Devreese K.M.J. (2012) Standardization of antiphospholipid antibody assays. Where do we stand? Lupus, 21: 718–721.
- Devreese K.M.J. (2014) Antiphospholipid antibody testing and standardization. Int. Jnl. Lab. Hem., 36: 352–363.
- Devreese K.M.J., De Laat B. (2015) Mixing studies in lupus anticoagulant testing are required at least in some type of samples. J. Thromb. Haemost., 13: 1475–1478.
- Favaloro E.J. (2013) Variability and diagnostic utility of antiphospholipid antibodies including lupus anticoagulants. Int. Jnl. Lab. Hem., 35: 269–274.
- Favaloro E.J., Bonar R., Zebeljan D. et al. (2010) Laboratory investigation of lupus anticoagulants: Mixing studies are sometimes required. J. Thromb. Haemost., 8: 2828–2831.
- Fritsma G.A., Dembitzer F.R., Randhawa A. et al. (2012) Recommendations for appropriate activated partial thromboplastin time reagent selection and utilization. Am. J. Clin. Pathol., 137: 904–908.
- Giannakopoulos B., Passam F., Ioannou Y., Krilis S.A. (2009) How we diagnose the antiphospholipid syndrome. Blood, 113(5): 985–994.
- Keeling D., Mackie I., Moore G.W. et al. (2012) Guidelines on the investigation and management of antiphospholipid syndrome. Br. J. Haematol., 157: 47–58.
- Kitchen S., McCraw A. (2000) Diagnosis of haemophilia and other bleeding disorders. A laboratory manual. WFH, Montreal, Саnada, 105 p.
- Kitchen S., McCraw A., Echenagucia M. (2010) Diagnosis of haemophilia and other bleeding disorders. A laboratory manual. 2nd ed., WFH, Montreal, Саnada, 144 p.
- Kumano O., Ieko M., Naito S. et al. (2013) Index of circulating anticoagulant cut-off value establishment in activated partial thromboplastin time mixing test for lupus anticoagulant diagnosis. J. Thromb. Haemost.; 11: 1919–1922.
- Martinuzzo M. (2010) Laboratory criteria of antiphospholipid syndrome need to be updated or strictly followed? Open Autoim. Jnl., 2: 28–37.
- Merashli M., Noureldine M.H.A., Uthman I. et al. (2015) Antiphospholipid syndrome: an update. Eur. J. Clin. Investig., 45: 653–662.
- Miyakis S., Lockshin M.D., Atsumi T. et al. (2006) International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J. Thromb. Haemost., 4: 295–306.
- Moore G.W. (2014a) Commonalities and contrasts in recent guidelines for lupus anticoagulant detection. Int. Jnl. Lab. Hem., 36: 364–373.
- Moore G.W. (2014b) Recent guidelines and recommendations for laboratory detection of lupus anticoagulants. Semin. Thromb. Hemost., 40: 163–171.
- Moore G.W. (2016) Current controversies in lupus anticoagulant detection. Antibodies, 5: 22.
- Pengo V., Banzato A., Bison E. et al. (2016) Laboratory testing for antiphospholipid syndrome. Int. Jnl. Lab. Hem., 38(1): 27–31.
- Pengo V., Tripodi A., Reber G. et al. (2009) Update of the guidelines for lupus anticoagulant detection. J. Thromb. Haemost., 7: 1737–1740.
- Sakakura M., Wada H., Watanabe R. et al. (2000) Coagulation tests and anti-phospholipid antibodies in patients positive for lupus anticoagulant. Clin. Applied Thromb. Hemost., 6: 144–150.
- Swadzba J., Iwaniec T., Pulka M. еt al. (2011) Lupus anticoagulant: performance of the tests as recommended by the latest ISTH guidelines. J. Thromb. Haemost., 9: 1776–1783.
- Tripodi A. (2007) Laboratory testing for lupus anticoagulants: a review of issues affecting results. Clin. Chemistry, 53(9): 1629–1635.
- Tripodi A. (2012) To mix or not to mix in lupus anticoagulant testing? That is the question. Semin. Thromb. Hemost., 38: 385–389.
- Tripodi A., deGroot P.G., Pengo V. (2011) Antiphospholipid syndrome: laboratory detection, mechanisms of action and treatment. J. Intern. Med., 270: 110–122.