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Survey on current practice in thrombophilia testing: from phenotype to genotype. Communication from the SSC of the ISTH.

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Toward harmonized interpretation of anticardiolipin and anti-β2-glycoprotein I antibody detection for diagnosis of antiphospholipid syndrome using defined level intervals and likelihood ratios: communication from the ISTH SSC Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibodies.

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Lupus Anticoagulant Testing: Dilute Prothrombin Time (dPT).

Gary W Moore1,2,3

  • 1Research and Development, Technoclone Herstellung von Diagnostika und Arzneimitteln GmbH, Vienna, Austria. gary.moore@addenbrookes.nhs.uk.

Methods in Molecular Biology (Clifton, N.J.)
|May 19, 2023
PubMed
Summary

A dilute prothrombin time (dPT) test effectively detects lupus anticoagulants (LA), which are often missed by standard assays. This method improves diagnostic accuracy for these clinically significant antibodies.

Keywords:
Antiphospholipid antibodiesAntiphospholipid syndromeDilute prothrombin timeLupus anticoagulantPhospholipidThromboplastinThrombosis

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Area of Science:

  • Hematology
  • Clinical Chemistry
  • Immunology

Background:

  • Lupus anticoagulants (LA) are antibodies that interfere with blood clotting.
  • Standard prothrombin time (PT) assays are insensitive to LA due to high phospholipid content.
  • LA detection is crucial for diagnosing thrombotic disorders.

Purpose of the Study:

  • To evaluate the dilute prothrombin time (dPT) assay for lupus anticoagulant detection.
  • To assess the performance of recombinant thromboplastins in dPT assays.
  • To improve the diagnostic sensitivity for clinically significant LA.

Main Methods:

  • Developed a dPT screening test by diluting thromboplastin reagents.
  • Utilized recombinant thromboplastins for enhanced assay performance.
  • Performed confirmatory testing with varying thromboplastin dilutions and mixing studies.

Main Results:

  • The dPT assay demonstrated sensitivity to LA, unlike standard PT assays.
  • Recombinant thromboplastins improved technical and diagnostic performance.
  • Confirmatory tests confirmed the phospholipid-dependent nature of LA.
  • Mixing tests aided in differentiating LA from factor deficiencies.

Conclusions:

  • The dPT assay is a valuable tool for detecting LA, especially those missed by other tests.
  • Incorporating dPT into routine testing increases the detection rate of clinically significant LA.
  • This assay enhances the diagnosis of thrombotic conditions associated with LA.