Measurement of Lupus Anticoagulants: An Update on Quality in Laboratory Testing

Adams, Murray J.

doi:10.1055/s-0033-1334864

Cited by 21 publications

(25 citation statements)

References 34 publications

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“…The Journal of on May 10, 2018 -Published by www.jrheum.org Downloaded from ulant (LAC) positivity, on at least 2 occasions 12 weeks apart 2,3,4,5 . In addition to these laboratory criteria, patients suspected of APS must fulfill at least 1 of 2 clinical criteria: vascular thrombosis or pregnancy morbidity.…”

Section: Rheumatologymentioning

confidence: 99%

Closing the Serological Gap in the Antiphospholipid Syndrome: The Value of “Non-criteria” Antiphospholipid Antibodies

Zohoury

Bertolaccini²,

Rodríguez-García³

et al. 2017

J Rheumatol

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Objective.Most clinicians use the 2006 Sydney classification criteria to evaluate patients suspected of having antiphospholipid syndrome (APS). Although sensitive and specific for APS, many patients fulfilling clinical criteria for the syndrome are persistently negative for the specific serological tests (“laboratory criteria”). These “seronegative APS” (SN-APS) patients can go undiagnosed and untreated until they experience serious clinical events. This study’s objective was to describe antibody profiles of SN-APS patients using non-criteria markers, assess the clinical utility of these markers separately and in combination, and suggest incorporation into guidelines for patients suspected of APS.Methods.We categorized 175 consecutive patients suspected of APS into 2 subgroups: 107 fulfilling Sydney APS classification for seropositive APS (SP-APS) and 68 with clinical manifestations suggestive of APS but having negative serology, on 2 occasions, for criteria markers (SN-APS). On study inclusion, samples were retested for criteria and 11 non-criteria markers, including antiphosphatidylserine/prothrombin antibodies.Results.Using 4 of 11 non-criteria tests, a cumulative 30.9% of SN-APS patients were detected. Combining results of all 11 non-criteria tests, 25 SN-APS (36.8%) and 89 SP-APS (83.2%) were positive for 1 or more non-criteria antibodies.Conclusion.Failure to diagnose APS can result in severe clinical consequences. Patients displaying clinical features of APS, but negative for conventional criteria markers, should undergo additional testing for non-criteria biomarkers. In our cohort, around one-third of SN-APS patients showed reactivity to 1 or more non-criteria markers. An update to the current classification criteria incorporating new serological markers should be considered to identify and stratify patients with APS for more effective treatment and management.

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Section: Rheumatologymentioning

confidence: 99%

Closing the Serological Gap in the Antiphospholipid Syndrome: The Value of “Non-criteria” Antiphospholipid Antibodies

Zohoury

Bertolaccini²,

Rodríguez-García³

et al. 2017

J Rheumatol

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“…9 If functional assays for some reason are not available, screening based on APTT for clotting factor inhibitors and mixing studies on a more or less regular basis might be options to guide the clinician. It might be difficult to differentiate between lupus anticoagulants and coagulation factor inhibitors in the screening situation.…”

Section: How To Perform Inhib Itor a Ssays?mentioning

confidence: 99%

The role of the laboratory in diagnosis and management of inhibitory antibodies in haemophilia

Strandberg¹,

Astermark

2018

Haemophilia

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The treatment of patients with haemophilia A has remarkably improved over the years and the journey to a potential cure continues. Replacement therapy has been the cornerstone of treatment, and, despite major advances, the development of neutralizing antibodies, eg inhibitors, has thus far not been possible to avoid. How, and to what extent, the new non-factor-based options will modify treatment strategy and inhibitor risk is unclear and it is essential that every haemophilia treatment centre is linked to an educated and skilled laboratory performing the relevant inhibitor assays. The current review will focus on when to consider and how to perform inhibitor assay(s) in the management of patients with haemophilia A.

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“…A prolongation of this test can hence be due to a deficiency of the leading factors of the intrinsic pathway (i.e., FXI, FIX and FVIII), as well as that of FXII and of the leading factors of the common pathway (i.e., FX, FV, FII and fibrinogen) (FIGURE 3). Notably, pathological prolongations of APTT are also commonplace during heparin therapy (especially unfractionated heparin) or for supratherapeutic dose of low molecular weight heparin, lupus anticoagulant (LAC), disseminated intravascular coagulation (DIC), vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs, i.e., especially dabigratan) [65,[67][68][69][70][71][72]. Indeed, the APTT is in some laboratories more often employed to help monitor heparin therapy and as part of a test panel to identify the LAC [67,71,72], than to assess for patient's hemostatic status.…”

Section: First-line (Routine Coagulation) Testsmentioning

confidence: 99%

Detection of mild inherited disorders of blood coagulation: current options and personal recommendations

Lippi

Pasalic

Favaloro

2015

Expert Review of Hematology

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Although assessment of prior personal and familial bleeding history is an important aspect of the diagnosis of bleeding disorders, patients with mild inherited bleeding disorders are sometimes clinically asymptomatic until presented with a hemostatic challenge. However, bleeding may occur after incursion of trauma or surgery, so detection of these conditions reflects an important facet of clinical and laboratory practice. Mild bleeding disorders may be detected as a result of family studies or following identification of abnormal values in first-line screening tests such as activated partial thromboplastin time, prothrombin time, fibrinogen and global platelet function screen testing, such as the platelet function analyzer. Following determination of abnormal screening tests, subsequent investigation should follow a systematic approach that targets specific diagnostic tests, and including factor assays, full platelet function assays and more extensive specialized hemostasis testing. The current report provides a personal overview on inherited disorders of blood coagulation and their detection.

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Measurement of Lupus Anticoagulants: An Update on Quality in Laboratory Testing

Cited by 21 publications

References 34 publications

Closing the Serological Gap in the Antiphospholipid Syndrome: The Value of “Non-criteria” Antiphospholipid Antibodies

Closing the Serological Gap in the Antiphospholipid Syndrome: The Value of “Non-criteria” Antiphospholipid Antibodies

The role of the laboratory in diagnosis and management of inhibitory antibodies in haemophilia

Detection of mild inherited disorders of blood coagulation: current options and personal recommendations

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