Laboratory Diagnosis of Lupus Inhibitors: A Comparison of the Tissue Thromboplastin Inhibition Procedure with a New Platelet Neutralization Procedure

Triplett, Douglas A.; Brandt, John; Kaczor, Daniel A.; Schaeffer, Janis

doi:10.1093/ajcp/79.6.678

Cited by 293 publications

(134 citation statements)

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“…IgG aCL antibodies with a titer of Ͼ15 IgG phospholipid units were regarded as positive. The presence of lupus anticoagulant was screened for by a dilute Russell's viper venom time assay (21) and confirmed by platelet neutralization assay (22). An underlying inhibitor was suspected following failure to normalize the coagulation time in a 1:1 patient:control plasma mixing assay.…”

Section: Methodsmentioning

confidence: 99%

Systemic sclerosis is an independent risk factor for increased coronary artery calcium deposition

Mok¹,

Lau²,

Chiu³

et al. 2011

Arthritis & Rheumatism

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Objective. Endothelial dysfunction and inflammation are pathogenic mechanisms common to systemic sclerosis (SSc) and atherosclerosis. This study was undertaken to examine the relationship between coronary atherosclerosis, as assessed by the coronary artery calcium score (CACS), and conventional cardiovascular and disease-specific risk factors in SSc patients.Methods. The CACS was measured by computed tomography, and cardiovascular risk factors were examined in SSc patients and compared with controls matched for age, sex, and glycemic status. Disease activity score, antiphospholipid antibodies, highsensitivity C-reactive protein level, and erythrocyte sedimentation rate were measured in SSc patients. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were determined.Results. We recruited 53 SSc patients (50 women and 3 men) and 106 controls. The patients had a mean ؎ SD age of 53.1 ؎ 12.9 years and a median disease duration of 9 years. Compared to controls, SSc patients had significantly lower low-density lipoprotein (LDL) cholesterol levels (P ‫؍‬ 0.001), high-density lipoprotein cholesterol levels (P ‫؍‬ 0.01), diastolic blood pressure, waist circumference, and body mass index and were more likely to be receiving vasodilators (all P < 0.001). There was a significantly higher proportion of SSc patients among subjects with more severe coronary calcification (CACS >101) compared to those with lesser severity (CACS <100) (56.5% versus 29.4%; P ‫؍‬ 0.01). Multiple logistic regression analysis revealed SSc to be an independent determinant for a CACS >101 (OR 10.89 [95% CI 2.21-53.75], P ‫؍‬ 0.003) together with age and LDL cholesterol level after adjustment for other cardiovascular risk factors. Among diseasespecific factors, only disease duration (OR 1.14 [95% CI 1.02-1.27], P ‫؍‬ 0.02) was independently associated with more severe coronary calcification (CACS >101).Conclusion. Our findings indicate that SSc is an independent risk factor for coronary calcification, in addition to the conventional risk factors for coronary atherosclerosis, such as age and hypertension.

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Section: Methodsmentioning

confidence: 99%

Systemic sclerosis is an independent risk factor for increased coronary artery calcium deposition

Mok¹,

Lau²,

Chiu³

et al. 2011

Arthritis & Rheumatism

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“…The activated partial thromboplastin time (APTT) was measured routinely in all lupus patients at every visit. Investigations for circulating lupus anticoagulant in patients who had prolonged APTT were made by appropriate mixing studies and a confirmatory test, such as the tissue thromboplastin inhibition test or the platelet neutralization procedure (19).…”

Section: Methodsmentioning

confidence: 99%

Lupus retinopathy

Stafford-Brady

Urowitz

Gladman

et al. 1988

Arthritis & Rheumatism

183

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In a prospective study of 550 patients with systemic lupus erythematosus (SLE), 41 were found to have retinopathy. Lupus retinopathy in the majority of cases consisted of a microangiopathy, with an excellent prognosis for vision. Five patients developed other complications that resulted in loss of visual acuity. Lupus retinopathy was associated with active SLE in 88% of patients and with lupus cerebritis in 73% of cases. Retinopathy in SLE was a marker of poor prognosis for survival.

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“…Many confirmatory procedures are available. In some, aged platelets may be used in combination with the APTT or the dRVVT as a convenient source of phospholipids after cycles of freezing and thawing (35 ). Other procedures use synthetic phospholipids, either bilayer or hexagonal (II) phase, in combination with the dRVVT, APTT, or SCT (36,37 ).…”

Section: Confirmatory Testsmentioning

confidence: 99%

Laboratory Testing for Lupus Anticoagulants: A Review of Issues Affecting Results

Tripodi

2007

Clinical Chemistry

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Background: Lupus anticoagulants (LA) are a heterogeneous class of immunoglobulins. Persistent LA positivity is a risk factor for the occurrence and recurrence of venous/arterial thromboembolism and/or pregnancy morbidity and qualifies the patient for anticoagulation therapy. The laboratory diagnosis for LA that is used for crucial decision-making about the optimal duration of the therapy rests entirely on diagnostic criteria. These criteria are based on the prolongation of phospholipiddependent tests not corrected upon mixing patient and normal plasmas, with confirmation provided by the evidence that the anticoagulant is directed against proteins bound to negatively charged phospholipids. Aims: This article reviews issues related to the diagnosis of LA, including the effect of preanalytical variables, choice of tests, results interpretation of screening, mixing and confirmation procedures, patients to be investigated, and transmission of results. Unresolved issues and future direction for research on laboratory diagnosis are also discussed. Methods: Search of PubMed with the key term "lupus anticoagulant" plus articles and unpublished data known to the author. Results and Conclusions: The preanalytical variables (i.e., plasma preparation and storage before analysis) as well as the diagnostic steps to detect LA present potential problems that undermine the process of making a correct diagnosis. A truly specific test for LA detection is badly needed, but its development may require understanding of the mechanisms associated with the occurrence of clinical events. Until then, clinical laboratories should rely on the existing procedures, which must be

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Laboratory Diagnosis of Lupus Inhibitors: A Comparison of the Tissue Thromboplastin Inhibition Procedure with a New Platelet Neutralization Procedure

Cited by 293 publications

References 0 publications

Systemic sclerosis is an independent risk factor for increased coronary artery calcium deposition

Systemic sclerosis is an independent risk factor for increased coronary artery calcium deposition

Lupus retinopathy

Laboratory Testing for Lupus Anticoagulants: A Review of Issues Affecting Results

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