[A study on evaluation of circulating anticoagulant in borderline cases]

Area of Science:

• Hematology
• Immunology
• Clinical Diagnostics

Context:

• Circulating anticoagulant (CA) detection is vital for managing patients with systemic lupus erythematosus (SLE), recurrent pregnancy loss, and other hemorrhagic or thrombotic conditions.
• A significant portion of patients present with borderline CA results, complicating accurate diagnosis and risk assessment.
• Distinguishing true positive CA from borderline results is essential for appropriate clinical management.

Purpose:

• To investigate the utility of diluted activated partial thromboplastin time (APTT) and prothrombin time (PT) reagents for clarifying borderline circulating anticoagulant (CA) results.
• To improve the diagnostic accuracy of CA detection in patients with ambiguous test patterns.
• To explore the association between borderline CA and the presence of anti-cardiolipin antibodies, indicative of lupus anticoagulants.

Summary:

• This study analyzed 83 patients with hemorrhagic and thrombotic disorders, finding 37% positive CA, 19% negative CA, and 44% borderline CA.
• Employing diluted APTT (5% reagent) and PT (50% reagent) assays, 70% (7 of 10) of borderline CA cases were reclassified as positive.
• Two additional borderline cases tested positive for anti-cardiolipin antibodies, further supporting the presence of lupus anticoagulants.

Impact:

• The findings suggest that borderline CA results should be interpreted as positive, potentially indicating lupus anticoagulants.
• This improved diagnostic approach can lead to more accurate risk stratification and timely therapeutic interventions for patients with thrombotic and hemorrhagic tendencies.
• Enhanced detection of circulating anticoagulants, particularly lupus anticoagulants, can significantly impact patient management in SLE and related disorders.