Antiphospholipid antibodies: guidelines for determination

Although significant progress has been made during the last decade in our knowledge of the antiphospholipid antibodies (aPL), there are two major questions in clinical practice that require further guidelines: Indications for aPL determination and laboratory tests to choose. This article reviews the main clinical indications to search for aPL (systemic lupus erythematosus, selected autoimmune conditions, spontaneous venous and arterial thrombosis, recurrent fetal losses, and autoimmune thrombocytopenia, among others) as well as the routine tests to detect aPL (serological tests for syphilis, lupus anticoagulant tests, solid phase techniques to detect anticardiolipin and other aPL and antibodies to aPL cofactors). Finally, a complete work-up is suggested for those patients with clinical manifestations of the aPL syndrome but without detection of aPL in the routine tests ("seronegative" aPL syndrome).