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Related Experiment Videos

Screening for the lupus anticoagulant.

D A Triplett1

  • 1Department of Pathology, Ball Memorial Hospital, Muncie, IN.

La Ricerca in Clinica E in Laboratorio
|October 1, 1989
PubMed
Summary

Lupus anticoagulants are immunoglobulins causing coagulation test interference. Recent studies link them to serious clinical issues, prompting increased laboratory demand for their detection and diagnosis.

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Area of Science:

  • Hematology
  • Immunology
  • Clinical Chemistry

Background:

  • Lupus anticoagulants (LA) are immunoglobulins (IgG, IgM, or both) interfering with in vitro phospholipid-dependent coagulation tests.
  • Historically viewed as a lab nuisance, LA are now linked to significant clinical conditions like thromboembolism and obstetrical complications.
  • Increased clinical associations necessitate accurate laboratory identification of LA in at-risk patient populations.

Purpose of the Study:

  • To review and highlight the diagnostic approaches for lupus anticoagulants.
  • To emphasize the clinical significance and evolving understanding of lupus anticoagulants.
  • To discuss the methodologies for detecting and confirming the presence of lupus anticoagulants.

Main Methods:

  • Utilizing phospholipid-dependent coagulation assays, including screening tests like the activated partial thromboplastin time (APTT).
  • Employing immunologic assays such as radioimmunoassay (RIA) or enzyme-linked immunosorbent assay (ELISA) to detect phospholipid antibodies.
  • Implementing confirmatory tests, including mixing studies, plasma agarose gels, and phospholipid-specific assays (e.g., phospholipid-depleted or altered systems).

Main Results:

  • Screening tests with reduced phospholipid content, particularly APTT, demonstrate enhanced sensitivity to lupus anticoagulants.
  • Test sensitivity is inversely related to the residual platelet count in patient samples.
  • Confirmatory methods are crucial to establish the inhibitor's presence and phospholipid specificity.

Conclusions:

  • Lupus anticoagulants are clinically relevant and require accurate laboratory diagnosis.
  • Optimized screening tests, especially those with decreased phospholipids, improve LA detection.
  • A multi-step diagnostic approach, including confirmation of inhibition and phospholipid specificity, is essential for accurate LA identification.

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