Practical Considerations and Testing Nuances for the Detection of Lupus Anticoagulant : Do Low Phospholipid Screen Results, Assay Type, and Test Ratio Matter?
© American Society for Clinical Pathology, 2021. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com..
OBJECTIVES: Lupus anticoagulant (LA) detection requires (1) prolongation of a phospholipid (PL)-dependent clot-based screening assay, (2) noncorrection upon adding normal pooled plasma, and (3) a confirmatory PL dependency test. Paired LA assays run screening and confirmatory tests simultaneously, with their test ratio (TR) or differences used to evaluate test results. We evaluated patients whose paired testing demonstrated PL dependence suggestive of LA, yet the low PL screen was not prolonged.
METHODS: Clinical and laboratory parameters are compared across (1) true positive (screen prolonged, TR positive) vs borderline (screen not prolonged, TR positive); (2) low-, moderate-, and high-TR subgroups; and (3) dilute Russell viper venom time (dRVVT) vs silica clotting time (SCT).
RESULTS: Borderline samples are not statistically different from true positives in their rate of repeat LA positivity or association with other anti-PL antibodies. Compared with true positives, borderline dRVVT is more frequent in pregnancy, women, and younger age. Elevated activated partial thromboplastin time is more frequent in true-positive dRVVT and SCT vs borderline and with an increasing dRVVT TR. LA persistence is more frequent with an increasing SCT TR. In addition, dRVVT true positivity is more frequent with thromboembolic events, while SCT is more frequent with autoimmunity and pregnancy complications.
CONCLUSIONS: Negative low-PL screens may not necessarily lack LA. A reevaluation of the laboratory criteria for LA detection may be needed.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:156 |
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| Enthalten in: |
American journal of clinical pathology - 156(2021), 6 vom: 08. Nov., Seite 1073-1082 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Asakrah, Saja [VerfasserIn] |
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| Links: |
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| Themen: |
Antibodies, Antiphospholipid |
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| Anmerkungen: |
Date Completed 06.01.2022 Date Revised 06.01.2022 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/ajcp/aqab069 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM326238727 |
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| 245 | 1 | 0 | |a Practical Considerations and Testing Nuances for the Detection of Lupus Anticoagulant |b Do Low Phospholipid Screen Results, Assay Type, and Test Ratio Matter? |
| 264 | 1 | |c 2021 | |
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| 500 | |a Date Completed 06.01.2022 | ||
| 500 | |a Date Revised 06.01.2022 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © American Society for Clinical Pathology, 2021. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com. | ||
| 520 | |a OBJECTIVES: Lupus anticoagulant (LA) detection requires (1) prolongation of a phospholipid (PL)-dependent clot-based screening assay, (2) noncorrection upon adding normal pooled plasma, and (3) a confirmatory PL dependency test. Paired LA assays run screening and confirmatory tests simultaneously, with their test ratio (TR) or differences used to evaluate test results. We evaluated patients whose paired testing demonstrated PL dependence suggestive of LA, yet the low PL screen was not prolonged | ||
| 520 | |a METHODS: Clinical and laboratory parameters are compared across (1) true positive (screen prolonged, TR positive) vs borderline (screen not prolonged, TR positive); (2) low-, moderate-, and high-TR subgroups; and (3) dilute Russell viper venom time (dRVVT) vs silica clotting time (SCT) | ||
| 520 | |a RESULTS: Borderline samples are not statistically different from true positives in their rate of repeat LA positivity or association with other anti-PL antibodies. Compared with true positives, borderline dRVVT is more frequent in pregnancy, women, and younger age. Elevated activated partial thromboplastin time is more frequent in true-positive dRVVT and SCT vs borderline and with an increasing dRVVT TR. LA persistence is more frequent with an increasing SCT TR. In addition, dRVVT true positivity is more frequent with thromboembolic events, while SCT is more frequent with autoimmunity and pregnancy complications | ||
| 520 | |a CONCLUSIONS: Negative low-PL screens may not necessarily lack LA. A reevaluation of the laboratory criteria for LA detection may be needed | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Antiphospholipid syndrome | |
| 650 | 4 | |a Clinical laboratory techniques | |
| 650 | 4 | |a Lupus anticoagulant inhibitors | |
| 650 | 4 | |a Thrombophilia | |
| 650 | 7 | |a Antibodies, Antiphospholipid |2 NLM | |
| 650 | 7 | |a Lupus Coagulation Inhibitor |2 NLM | |
| 650 | 7 | |a Phospholipids |2 NLM | |
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| 700 | 1 | |a Bhargava, Parul |e verfasserin |4 aut | |
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