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Thromb Haemost 1997; 77(02): 336-342
DOI: 10.1055/s-0038-1655965
Original Article
Schattauer GmbH Stuttgart

Evaluation of Sensitivity and Specificity of a Standardized Procedure Using Different Reagents for the Detection of Lupus Anticoagulants

J Goudemand
1   Laboratoire d’Hématologie, Hôpital Huriez, Lille
,
C Caron
1   Laboratoire d’Hématologie, Hôpital Huriez, Lille
,
D De Prost
2   Service d’Hématologie, Hôpital Bichat, Paris
,
A Derlon
3   Laboratoire d’Hématologie, CHRU Côte de Nacre, Caen
,
J Y Borg
4   Laboratoire d’Hématologie, Hôpital Charles Nicolle, Rouen
,
J Sampol
5   Laboratoire d’Hématologie, Faculté de Pharmacie, Marseille
,
P Sié
6   Laboratoire d’Hématologie, Hôpital Purpan, Toulouse, France
,
for the Working Group on Hemostasis of the Société Française de Biologie Clinique and for the Groupe d’Etudes sur I’Hémostase et la Thrombose › Author Affiliations
Further Information

Publication History

Received 31 July 1996

Accepted after revision 09 October 1996

Publication Date:
10 July 2018 (online)

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Summary

This study was designed to test the sensitivity and specificity of a combination of 3 phospholipid-dependent assays performed with various reagents, for the detection of lupus anticoagulant (LA). Plasmas containing an LA (n = 56) or displaying various confounding pathologies [58 intrinsic pathway factor deficiencies, 9 factor VIII inhibitors, 28 plasmas from patients treated with an oral anticoagulant (OAC)] were selected. In a first step, the efficiency of each assay and reagent was assessed using the Receiving Operating Characteristic (ROC) method. Optimal cut-offs providing both sensitivity and specificity ≥80% were determined. The APTT assay and most of the phospholipid neutralization assays failed to discriminate factor VIII inhibitors from LA. In a second step, using the optimal cut-offs determined above, the results of all the possible combinations of the 3 assays performed with 4 different reagents were analyzed. Thirteen combinations of reagents allowed ≥ 80% of plasmas of each category (LA, factor deficiency or OAC) to be correctly classified (3/3 positive test results in LA-containing plasmas and 0/3 positive results in LA-negative samples).

 

  • References

  • 1 Mc NeilHP, Simpson RJ, Chesterman CN, Krilis SA. Antiphospholipid antibodies are directed against a complex antigen that includes a lipid-binding inhibitor of coagulation:β2-glycoprotein I (apolipoprotein H). Proc Natl Acad Sci USA 1990; 87: 4120-4124
    CrossrefPubMedGoogle Scholar
  • 2 Bevers EM, Galli M, Barbui T, Comfurius P, Zwaal RFA. Lupus anticoagulant IgG’s (LA) are not directed to phospholipids only but to a complex of lipid-bound human prothrombin. Thromb Haemost 1991; 66: 629-632
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Galli M, Comfurius P, Maasen C, Hemkers HC, De BaetsMH, van Breda-VriesmanPJC, Barbui T, Zwaal RFA, Bevers EM. Anticardiolipin antibodies (ACA) are directed not to cardiolipin but to a plasma protein cofactor. Lancet 1990; 335: 1544-1547
    CrossrefPubMedGoogle Scholar
  • 4 Triplett DA. Antiphospholipid-protein antibodies:laboratory detection and clinical relevance. Thromb Res 1995; 78: 01-31
    CrossrefPubMedGoogle Scholar
  • 5 Harris EN, Gharavi AE, Boey ML. Anticardiolipin antibodies:detection by radioimmunoassay and association with thrombosis in systemic lupus erythematosus. Lancet 1983; 02: 1211-1214
    PubMedGoogle Scholar
  • 6 Hughes GRV. Thrombosis, abortion, cerebral diseas and the lupus anticoagulant. Br Med J 1983; 287: 1088-1089
    CrossrefPubMedGoogle Scholar
  • 7 Hughes GRV. The antiphospholipid syndrome:ten years on. Lancet 1993; 343: 341-344
    PubMedGoogle Scholar
  • 8 Triplett DA. Antiphospholipid antibody syndromes. In: Hypercoagulable states. Fundamental aspects, acquired disorders and congenital thrombophilia Seghatchian MJ, Samama MM, Hecker SP. eds. CRC Press; Boca Raton, New York, London, Tokyo (PA): 1996. pp 223-232
    Google Scholar
  • 9 Exner T, Triplett DA, Taberner D, Machin SJ. Guidelines for testing and revised criteria for lupus anticoagulants. Thromb Haemost 1991; 65: 320-322
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Brandt JT, Triplett DA, Alving B, Scharrer I. Criteria for the diagnosis of lupus anticoagulants:an update. Thromb Haemost 1995; 74: 1185-1190
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Working group on Haemostasis of the SociétéFrangaise de Biologie Clinique. Comparison of a standardized procedure with current laboratory practices for the detection of lupus anticoagulant in France. Thromb Haemost 1993; 70: 781-786
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Adcock DM, Marlar RA. Activated partial thromboplastin time reagent sensitivity to the presence of lupus anticoagulants. Arch pathol Lab Med 1992; 116: 837-840
    PubMedGoogle Scholar
  • 13 Brandt JT, Triplett DA, Musgrave K, Orr CA. The sensitivity of different coagulation reagents to the presence of lupus anticoagulants. Arch Pathol Lab Med 1987; 111: 120-124
    PubMedGoogle Scholar
  • 14 Brandt JT, Barna LK, Triplett DA. Laboratory identification of lupus anticoagulants:results of the second international workshop for identification of lupus anticoagulants. On behalf of the Subcommittee on Lupus Anticoagulants/Antiphospholipid Antibodies of the ISTH. Thromb Haemost 1995; 74: 1597-1603
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Denis-Magdelaine A, Flahaud A, Verdy E. Sensitivity of sixteen reagents for the presence of lupus anticoagulants. Haemostasis 1995; 25: 98-105
    PubMedGoogle Scholar
  • 16 Kasper CK, Aledort LM, Counts RB, Edson JR, Frantantoni J, Green D, Hampton JW, Hilgartner MW, Lazerson J, Levine PH, Me MillanCW, Pool JG, Shapiro SS, Schulman NR, Van EysJ. A more uniform measurement of factor VIII inhibitors. Thromb Diath Haemorrh 1975; 34: 869-872
    PubMedGoogle Scholar
  • 17 Rosner E, Pauzner R, Lusky A, Modan M, Many A. Detection and quantitative evaluation of lupus circulating anticoagulant activity. Thromb Haemost 1987; 57: 144-147
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Rosove MH, Ismail M, Koziol BJ, Runge A, Kasper CK. Lupus anticoagulants:improved diagnosis with a kaolin clotting time using rabbit brain phospholipid in standard and high concentrations. Blood 1986; 68: 472-478
    PubMedGoogle Scholar
  • 19 Arnout J, Vanrusselt M, Huybrechts E, Vermylen J. Optimization of the dilute prothrombin time for the detection of the lupus anticoagulant by use of a recombinant tissue thromboplastin. Br J Haematol 1994; 87: 94-99
    CrossrefPubMedGoogle Scholar
  • 20 Forastiero RR, Cerrato GS, Carreras LO. Evaluation of recently described tests for the detection of the lupus anticoagulant. Thromb Haemost 1994; 72: 728-733
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Jaeger U, Kapiotis S, Pablinger I, Puchhammer E, Kyrle P, Lechner K. Transient lupus anticoagulant associated with hypoprothrombinaemia and factor XII deficiency following adenovirus infection. Annals Haematol 1993; 67: 95-99
    PubMedGoogle Scholar
  • 22 Endo Y. Congenital factor XII deficiency and lupus anticoagulant. Intern Med 1994; 33: 188
    CrossrefPubMedGoogle Scholar
  • 23 Brookfield C, Malia RG, Cooper SM, Greaves M. Factor XII levels and the lupus anticoagulant. Thromb Haemost 1995; 73: 1441
    PubMedGoogle Scholar
  • 24 Jones DW, Gallimore MJ, Winter M. Pseudo factor XII deficiency and phospholipid antibodies. Thromb Haemost 1996; 75: 693-697
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Kasper GK. Laboratory tests for factor VIII inhibitors, their variation, signification and interpretation. Blood Coag Fibrinol 1991; 2 (Suppl. 01) 07-10
    CrossrefPubMedGoogle Scholar
  • 26 Triplett DA, Bama LK, Unger GA. A hexagonal (II) phase phospholipid neutralization assay for lupus anticoagulant identification. Thromb Haemost 1993; 70: 787-793
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Exner T, Rickard KA, Kronenberg H. A sensitive test demonstrating lupus anticoagulants and its behavioral patterns. Br J Haematol 1978; 40: 143-151
    CrossrefPubMedGoogle Scholar
  • 28 Thiagarajan P, Pengo V, Shapiro S. The use of dilute Russel viper venom time for the diagnosis of lupus anticoagulants. Blood 1986; 68: 869-874
    PubMedGoogle Scholar
  • 29 Triplett DA, Stocker KF, Unger GA, Bama UK. The Textarin/Ecarin ratio:a confirmatory test for lupus anticoagulants. Thromb Haemost 1993; 70: 925-932
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Rooney AM, Mc NallyT, Mackie IJ, Machin SJ. The Taipan snake venom time:a new test for lupus anticoagulant. J Clin Pathol 1994; 47: 497-501
    CrossrefPubMedGoogle Scholar
  • 31 Galli M, Bevers EM, Comfurius P, Barbui T, Zwaal RF. Effect of antiphospholipid antibodies on procoagulant activity of activated platelets and platelet derived micro vesicles. Br J Haematol 1993; 83: 466-472
    CrossrefPubMedGoogle Scholar
  • 32 Galli M, Finazzi G, Bevers EM, Barbui T. Kaolin clotting time and dilute Russel’s viper venom time distinguish between prothrombin-dependent and β2-Glycoprotein I-dependent antiphospholipid antibodies. Blood 1995; 86: 617-623
    PubMedGoogle Scholar