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Thromb Haemost 2009; 101(01): 178-184
DOI: 10.1160/TH08-06-0353
New Technologies, Diagnostic Tools and Drugs
Schattauer GmbH

Are laboratories following published recommendations for lupus anticoagulant testing?

An international evaluation of practices
Karen M. Moffat
1   Hamilton Regional Laboratory Medicine Program, McMaster University, Hamilton, ON, Canada
2   McMaster University, Health Sciences Center, McMaster University, Hamilton, Ontario, Canada
5   North American Specialized Coagulation Laboratory Association (NASCOLA)
,
Marlies R. Ledford-Kraemer
3   CLOT-ED, Islamorada, Florida, USA
5   North American Specialized Coagulation Laboratory Association (NASCOLA)
,
Elizabeth A. Plumhoff
4   Mayo Clinic, Rochester, Minnesota, USA
5   North American Specialized Coagulation Laboratory Association (NASCOLA)
,
Heather McKay
2   McMaster University, Health Sciences Center, McMaster University, Hamilton, Ontario, Canada
,
William L. Nichols
4   Mayo Clinic, Rochester, Minnesota, USA
5   North American Specialized Coagulation Laboratory Association (NASCOLA)
,
Piet Meijer
6   ECAT Foundation, Leiden, The Netherlands
,
Catherine P. Hayward
1   Hamilton Regional Laboratory Medicine Program, McMaster University, Hamilton, ON, Canada
2   McMaster University, Health Sciences Center, McMaster University, Hamilton, Ontario, Canada
5   North American Specialized Coagulation Laboratory Association (NASCOLA)
› Author Affiliations
Further Information

Publication History

Received: 04 June 2008

Accepted after major revision: 12 September 2008

Publication Date:
23 November 2017 (online)

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Summary

Laboratory tests for lupus anticoagulants (LA) are commonly performed to evaluate thrombosis or suspected phospholipid antibody syndromes. To determine current LA testing practices, and if they conform to published recommendations, two questionnaires were distributed to clinical laboratory members of the North American Specialized Coagulation Laboratory Association (NASCOLA) and the ECAT Foundation (ECAT). The first and second questionnaires were completed by 113 and 96 laboratories, respectively. Commonly performed LA tests included the dilute Russell’s viper venom time, LA sensitive activated partial thromboplastin time and hexagonal phospholipid test. Although some laboratories did single LA tests if requested, the majority complied with published recommendations: to use platelet poor plasma for LA tests; to use two or more screening tests, representing different assay principles, and one assay having a low phospholipid concentration to exclude LA; to confirm LA phospholipid dependency by the method giving an abnormal LA screen; to document the inhibitor activity on pooled normal plasma; and not to use phospholipid antibodies to confirm LA. A minority (<35%) followed the recommendations to exclude factor deficiencies and factor inhibitors as the cause of an abnormal LA test. After participating, 32% of laboratories had changed practices and 20% indicated that they would be changing practices. While most laboratories generally follow published guidelines for LA testing, few follow recommendations to evaluate for other coagulation abnormalities. Questionnaires may be helpful quality initiatives to improve compliance with laboratory testing guidelines and recommendations.

Keywords

Lupus anticoagulant - phospholipid antibodies - coagulation inhibitors - ISTH guidelines
 

  • References

  • 1 de Laat HB, Derksen RH, Urbanus RT. et al. Beta2-glycoprotein I-dependent lupus anticoagulant highly correlates with thrombosis in the antiphospholipid syndrome. Blood 2004; 104: 3598-3602.
    CrossrefPubMedGoogle Scholar
  • 2 Simmelink MJ, Horbach DA, Derksen RH. et al. Complexes of anti-prothrombin antibodies and prothrombin cause lupus anticoagulant activity by competing with the binding of clotting factors for catalytic phospholipid surfaces. Br J Haematol 2001; 113: 621-629.
    CrossrefPubMedGoogle Scholar
  • 3 Tripodi A. Laboratory testing for lupus anticoagulants: a review of issues affecting results. Clin Chem 2007; 53: 1629-1635.
    CrossrefPubMedGoogle Scholar
  • 4 Brandt JT, Barna LK, Triplett DA. Laboratory identification of lupus anticoagulants: results of the Second International Workshop for Identification of Lupus Anticoagulants. On behalf of the Subcommittee on Lupus Anticoagulants/Antiphospholipid Antibodies of the ISTH. Thromb Haemost 1995; 74: 1597-1603.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Brandt JT, Triplett DA, Alving B. et al. Criteria for the diagnosis of lupus anticoagulants: an update. On behalf of the Subcommittee on Lupus Anticoagulant/ Antiphospholipid Antibody of the Scientific and Standardisation Committee of the ISTH. Thromb Haemost 1995; 74: 1185-1190.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 de Groot PG, Derksen RH. Antiphospholipid antibodies: update on detection, pathophysiology, and treatment. Curr Opin Hematol 2004; 11: 165-169.
    CrossrefPubMedGoogle Scholar
  • 7 de Groot PG, Bouma B, Lutters BC. et al. Lupus anticoagulant in cardiovascular diseases: the role of beta2-glycoprotein I. Ann Med 2000; 32 (Suppl. 01) 32-36.
    PubMedGoogle Scholar
  • 8 de Groot PG, Horbach DA, Simmelink MJ. et al. Anti-prothrombin antibodies and their relation with thrombosis and lupus anticoagulant. Lupus 1998; 07 (Suppl. 02) S32-S36.
    CrossrefPubMedGoogle Scholar
  • 9 Sailer T, Zoghlami C, Kurz C. et al. Anti-beta2-glycoprotein I antibodies are associated with pregnancy loss in women with the lupus anticoagulant. Thromb Haemost 2006; 95: 796-801.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Guidelines on testing for the lupus anticoagulant.. Lupus Anticoagulant Working Party on behalf of the BCSH Haemostasis and Thrombosis Task Force. J Clin Pathol 1991; 44: 885-889.
    CrossrefPubMedGoogle Scholar
  • 11 Galli M, Luciani D, Bertolini G. et al. Lupus anticoagulants are stronger risk factors for thrombosis than anticardiolipin antibodies in the antiphospholipid syndrome: a systematic review of the literature. Blood 2003; 101: 1827-1832.
    CrossrefPubMedGoogle Scholar
  • 12 Heit JA. Current management of acute symptomatic deep vein thrombosis. Am J Cardiovasc Drugs 2001; 01: 45-50.
    CrossrefPubMedGoogle Scholar
  • 13 Lim W, Crowther MA, Eikelboom JW. Management of antiphospholipid antibody syndrome: a systematic review. JAMA 2006; 295: 1050-1057.
    CrossrefPubMedGoogle Scholar
  • 14 Miyakis S, Lockshin MD, Atsumi T. et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006; 04: 295-306.
    CrossrefPubMedGoogle Scholar
  • 15 Triplett DA. Antiphospholipid antibodies. Arch Pathol Lab Med 2002; 126: 1424-1429.
    PubMedGoogle Scholar
  • 16 Exner T, Triplett DA, Taberner D. et al. Guidelines for testing and revised criteria for lupus anticoagulants. SSC Subcommittee for the Standardization of Lupus Anticoagulants. Thromb Haemost 1991; 65: 320-322.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Greaves M, Cohen H, Machin SJ. et al. Guidelines on the investigation and management of the antiphospholipid syndrome. Br J Haematol 2000; 109: 704-715.
    CrossrefPubMedGoogle Scholar
  • 18 Green D, Hougie C, Kazmier FJ. et al. Report of the Working Party on Acquired Inhibitors of Coagulation: studies of the “lupus” anticoagulant. Thromb Haemost 1983; 49: 144-146.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Wong RC, Adelstein S, Gillis D. et al. Development of consensus guidelines for anticardiolipin and lupus anticoagulant testing. Semin Thromb Hemost 2005; 31: 39-48.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Devreese KM. Interpretation of normal plasma mixing studies in the laboratory diagnosis of lupus anticoagulants. Thromb Res 2007; 119: 369-376.
    CrossrefPubMedGoogle Scholar
  • 21 Rosner E, Pauzner R, Lusky A. et al. Detection and quantitative evaluation of lupus circulating anticoagulant activity. Thromb Haemost 1987; 57: 144-147.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Lim S, Zuha R, Burt T. et al. Life-threatening bleeding in a patient with a lupus inhibitor and probable acquired factor VII deficiency. Blood Coagul Fibrinolysis 2006; 17: 667-671.
    CrossrefPubMedGoogle Scholar
  • 23 Teruya J, West AG, Suell MN. Lupus anticoagulant assays: questions answered and to be answered. Arch Pathol Lab Med 2007; 131: 885-889.
    PubMedGoogle Scholar
  • 24 Thom J, Ivey L, Eikelboom J. Normal plasma mixing studies in the laboratory diagnosis of lupus anticoagulant. J Thromb Haemost 2003; 01: 2689-2691.
    CrossrefPubMedGoogle Scholar
  • 25 Abo SM, DeBari VA. Laboratory evaluation of the antiphospholipid syndrome. Ann Clin Lab Sci 2007; 37: 3-14.
    PubMedGoogle Scholar
  • 26 Tripodi A, Chantarangkul V, Clerici M. et al. Laboratory diagnosis of lupus anticoagulants for patients on oral anticoagulant treatment. Performance of dilute Russell viper venom test and silica clotting time in comparison with Staclot LA. Thromb Haemost 2002; 88: 583-586.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Bertolaccini ML, Hughes GR. Antiphospholipid antibody testing: which are most useful for diagnosis?. Rheum Dis Clin North Am 2006; 32: 455-463.
    CrossrefPubMedGoogle Scholar
  • 28 Galli M, Reber G, de Moerloose P. et al. Invitation to a debate on the serological criteria that define the antiphospholipid syndrome. J Thromb Haemost 2008; 06: 399-401.
    CrossrefPubMedGoogle Scholar
  • 29 Le Querrec A, Arnout J, Arnoux D. et al. Quantification of lupus anticoagulants in clinical samples using anti-beta2GP1 and anti-prothrombin monoclonal antibodies. Thromb Haemost 2001; 86: 584-589.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Pengo V, Ruffatti A, Iliceto S. The diagnosis of the antiphospholipid syndrome. Pathophysiol Haemost Thromb 2006; 35: 175-180.
    CrossrefPubMedGoogle Scholar
  • 31 Wong RC, Gillis D, Adelstein S. et al. Consensus guidelines on anti-cardiolipin antibody testing and reporting. Pathology 2004; 36: 63-68.
    CrossrefPubMedGoogle Scholar
  • 32 Wong RC, Favaloro EJ, Adelstein S. et al. Consensus guidelines on anti-beta 2 glycoprotein I testing and reporting. Pathology 2008; 40: 58-63.
    CrossrefPubMedGoogle Scholar
  • 33 Arnout J, Meijer P, Vermylen J. Lupus anticoagulant testing in Europe: an analysis of results from the first European Concerted Action on Thrombophilia (ECAT) survey using plasmas spiked with monoclonal antibodies against human beta2-glycoprotein I. Thromb Haemost 1999; 81: 929-934.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Favaloro EJ, Bonar R, Duncan E. et al. Identification of factor inhibitors by diagnostic haemostasis laboratories: a large multi-centre evaluation. Thromb Haemost 2006; 96: 73-78.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Goudemand J, Caron C, De Prost D. et al. Evaluation of sensitivity and specificity of a standardized procedure using different reagents for the detection of lupus anticoagulants. The Working Group on Hemostasis of the Societe Francaise de Biologie Clinique and for the Groupe d’Etudes sur I’Hemostase et la Throm-bose. Thromb Haemost 1997; 77: 336-342.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Tripodi A, Biasiolo A, Chantarangkul V. et al. Lupus anticoagulant (LA) testing: performance of clinical laboratories assessed by a national survey using lyophilized affinity-purified immunoglobulin with LA activity. Clin Chem 2003; 49: 1608-1614.
    CrossrefPubMedGoogle Scholar
  • 37 Jennings I, Mackie I, Arnout J. et al. Lupus anticoagulant testing using plasma spiked with monoclonal antibodies: performance in the UK NEQAS proficiency testing programme. J Thromb Haemost 2004; 02: 2178-2184.
    CrossrefPubMedGoogle Scholar
  • 38 Jennings I, Greaves M, Mackie IJ. et al. Lupus anticoagulant testing: improvements in performance in a UK NEQAS proficiency testing exercise after dissemination of national guidelines on laboratory methods. Br J Haematol 2002; 119: 364-369.
    CrossrefPubMedGoogle Scholar