Diagnostic Challenges on the Laboratory Detection of Lupus Anticoagulant

Abstract

Lupus anticoagulant (LA) is one of the three laboratory parameters (the others being antibodies to either cardiolipin or β2-glycoprotein I) which defines the rare but potentially devastating condition known as antiphospholipid syndrome (APS). Testing for LA is a challenging task for the clinical laboratory because specific tests for its detection are not available. However, proper LA detection is paramount for patients’ management, as its persistent positivity in the presence of (previous or current) thrombotic events, candidate for long term anticoagulation. Guidelines for LA detection have been established and updated over the last two decades. Implementation of these guidelines across laboratories and participation to external quality assessment schemes are required to help standardize the diagnostic procedures and help clinicians for appropriate management of APS. This article aims to review the current state of the art and the challenges that clinical laboratories incur in the detection of LA.

Added value of antiphosphatidylserine/prothrombin antibodies in the workup of thrombotic antiphospholipid syndrome: Communication from the ISTH SSC Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibodies

“…30 Furthermore, laboratory diagnosis of APS is complicated by the methodology of LAC and solid phase assays, interference of anticoagulant treatment for LAC assessment, and presence of transient aPL in inflammatory/infectious conditions or with drugs. [4][5][6]31,32 Current laboratory criteria for APS diagnosis include assessment of aCL and aβ2GPI IgG/IgM with solid phase assays. 2 These techniques are sensitive and easy to perform, especially when automated platforms are used.…”

“…Additionally, aPL can circulate in healthy individuals and patients with AID or other conditions without ever developing the clinical phenotype of APS 30 . Furthermore, laboratory diagnosis of APS is complicated by the methodology of LAC and solid phase assays, interference of anticoagulant treatment for LAC assessment, and presence of transient aPL in inflammatory/infectious conditions or with drugs 4–6,31,32 . Current laboratory criteria for APS diagnosis include assessment of aCL and aβ2GPI IgG/IgM with solid phase assays 2 .…”

“…Detection of LAC is based on functional phospholipid‐dependent coagulation tests. Testing for LAC is challenging and can be complicated by concurrent anticoagulation therapy or presence of acute phase proteins 4,5 . aCL and aβ2GPI IgG/IgM are measured by solid phase assays using techniques such as enzyme‐linked immunosorbent assay (ELISA) or chemiluminescent immunoassay (CLIA) 6,7 .…”

“…Testing for LAC is challenging and can be complicated by concurrent anticoagulation therapy or presence of acute phase proteins. 4,5 aCL and aβ2GPI IgG/IgM are measured by solid phase assays using techniques such as enzyme-linked immunosorbent assay (ELISA) or chemiluminescent immunoassay (CLIA). 6,7 Solid phase assays are not prone to interferences as described for LAC assays but lack standardization and demonstrate intra-and inter-assay variation.…”

Direct oral anticoagulant adsorption and laboratory detection of lupus anticoagulant

“…Although many guidelines and recommendations have been published by authoritative scientific societies to define how, when and why LA test should be ordered, the detection of LA remains a challenging issue for the laboratory staff [5].…”