[Antiphospholipid syndrome: a new clinical entity? Part 1: antiphospholipid antibodies: specificity and...

A new clinical entity, the antiphospholipid syndrome, has recently been described. It is based on the detection of antiphospholipid antibodies either by coagulation tests or by ELISA assay. The precise epitopes towards which these antibodies are directed is a matter of controversy. It is even possible that the name antiphospholipid is inappropriate. The diagnosis of lupus like anticoagulant (LA) detected by coagulation tests requires a three step procedure after appropriate processing of plasma samples. Antiphospholipid antibodies can also be identified by ELISA; this assay is simpler, but there is still a need for standardization. LA and antiphospholipid antibodies identified by ELISA are similar, but not identical; they have similar clinical implications. Due to the heterogeneity of the antibodies and the antigens it is necessary to use a panel of tests to establish or exclude the presence of antiphospholipid antibodies. In the future a better knowledge of antibodies' specificity should help in selecting the most useful test for clinical purposes.