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Thromb Haemost 2009; 101(01): 178-184
DOI: 10.1160/TH08-06-0353
New Technologies, Diagnostic Tools and Drugs
Schattauer GmbH

Are laboratories following published recommendations for lupus anticoagulant testing?

An international evaluation of practices
Karen M. Moffat
1   Hamilton Regional Laboratory Medicine Program, McMaster University, Hamilton, ON, Canada
2   McMaster University, Health Sciences Center, McMaster University, Hamilton, Ontario, Canada
5   North American Specialized Coagulation Laboratory Association (NASCOLA)
,
Marlies R. Ledford-Kraemer
3   CLOT-ED, Islamorada, Florida, USA
5   North American Specialized Coagulation Laboratory Association (NASCOLA)
,
Elizabeth A. Plumhoff
4   Mayo Clinic, Rochester, Minnesota, USA
5   North American Specialized Coagulation Laboratory Association (NASCOLA)
,
Heather McKay
2   McMaster University, Health Sciences Center, McMaster University, Hamilton, Ontario, Canada
,
William L. Nichols
4   Mayo Clinic, Rochester, Minnesota, USA
5   North American Specialized Coagulation Laboratory Association (NASCOLA)
,
Piet Meijer
6   ECAT Foundation, Leiden, The Netherlands
,
Catherine P. Hayward
1   Hamilton Regional Laboratory Medicine Program, McMaster University, Hamilton, ON, Canada
2   McMaster University, Health Sciences Center, McMaster University, Hamilton, Ontario, Canada
5   North American Specialized Coagulation Laboratory Association (NASCOLA)
› Author Affiliations
Further Information

Publication History

Received: 04 June 2008

Accepted after major revision: 12 September 2008

Publication Date:
23 November 2017 (online)

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Summary

Laboratory tests for lupus anticoagulants (LA) are commonly performed to evaluate thrombosis or suspected phospholipid antibody syndromes. To determine current LA testing practices, and if they conform to published recommendations, two questionnaires were distributed to clinical laboratory members of the North American Specialized Coagulation Laboratory Association (NASCOLA) and the ECAT Foundation (ECAT). The first and second questionnaires were completed by 113 and 96 laboratories, respectively. Commonly performed LA tests included the dilute Russell’s viper venom time, LA sensitive activated partial thromboplastin time and hexagonal phospholipid test. Although some laboratories did single LA tests if requested, the majority complied with published recommendations: to use platelet poor plasma for LA tests; to use two or more screening tests, representing different assay principles, and one assay having a low phospholipid concentration to exclude LA; to confirm LA phospholipid dependency by the method giving an abnormal LA screen; to document the inhibitor activity on pooled normal plasma; and not to use phospholipid antibodies to confirm LA. A minority (<35%) followed the recommendations to exclude factor deficiencies and factor inhibitors as the cause of an abnormal LA test. After participating, 32% of laboratories had changed practices and 20% indicated that they would be changing practices. While most laboratories generally follow published guidelines for LA testing, few follow recommendations to evaluate for other coagulation abnormalities. Questionnaires may be helpful quality initiatives to improve compliance with laboratory testing guidelines and recommendations.

Keywords

Lupus anticoagulant - phospholipid antibodies - coagulation inhibitors - ISTH guidelines
 

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