Lupus anticoagulants: pathogenesis and laboratory diagnosis

Area of Science:

• Hematology
• Clinical Chemistry
• Immunology

Background:

• Lupus anticoagulant (LA) is a significant factor in thrombotic events.
• Extensive research has focused on understanding LA pathogenesis.
• Numerous laboratory tests have been developed for LA detection.

Purpose of the Study:

• To review the nature and pathogenesis of lupus anticoagulant (LA).
• To provide a comprehensive overview of diagnostic approaches for LA.
• To discuss diagnostic criteria, including pre-analytical variables and anticoagulant effects.

Main Methods:

• Review of established laboratory tests: kaolin clotting time (KCT), activated partial thromboplastin time (APTT), and tissue thromboplastin inhibition test (TTI).
• Evaluation of newer diagnostic methods: dilute Russell's viper venom time (DRVVT), textarin/ecarin ratio, and Taipan snake venom time (TSVT).
• Discussion of diagnostic criteria and influencing factors, such as sample preparation and therapeutic anticoagulants.

Main Results:

• A wide array of laboratory tests exist for LA detection, varying in methodology and sensitivity.
• Established tests like APTT and newer methods like DRVVT are commonly employed.
• Pre-analytical variables and therapeutic anticoagulants significantly impact test results and diagnostic accuracy.

Conclusions:

• Accurate diagnosis of LA requires careful selection and interpretation of laboratory tests.
• Understanding the nuances of different diagnostic methods is essential for effective patient management.
• Consideration of pre-analytical factors and confounding medications is critical for reliable LA diagnosis.