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KMID : 0384119930130020187
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Korean Journal of Clinical Pathology
1993 Volume.13 No. 2 p.187 ~ p.196
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Comparison of Laboratory Tests Used for Identification of the Lupus Anticoagulant
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Abstract
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With the well-documented association of lupus anticoagulant(LA) with thrombotic disease and immune disorders, the laboratory approach to diagnosing these inhibitors is more critical now. A comparison of the tests for LA was undertaken on LA
positive 70
patients who were initially presented with a prolonged activated partial thromboplastin time(aPTT) and/or prothrombin time(PT) or thrombotic problems. We used a battery of coagulation tests, including mixing aPTT(patient:control-1:1), tissue
thromboplastin inhibition test(TTI, 1:50 and 1:500 thromboplastin) and activated partial thromboplastin time with kaolin(aPTTK or KPTT, 1:50 and 1:500 thromboplastin). Thirty(42.8%) patients had prolongation of aPTT only and two(2.9%) patients
had
prolongation of PT only. Both tests of PT and aPTT were abnormal in twenty eight(40.0%) patients and normal in ten(14.3%) patients. In fifty nine(84.3%) patients. more than three out of five tests above were necessary to decide positivity for LA.
Both
TTI and aPTTK tests were sensitive assays, as the former was abnormal in 45 of 70*64.3%) and the latter was abnormal in 53 out of 70 patients(75.7%) respectively. Results of antiphospholipid antibodies(APA, ELISA) which were determined
simultaneously in
49 LA positive patients, showed that both tests were positive in 7 patients(14.3%) and the remaining 42 patients(85.7%) were negative for APA. Analysis of underlying diseases of patients with LA revealed that 53(75.7%) patients had cerebral
ischemia;
noncardiogenic and cardiogenic types were 46(65.7%) and 7(10%) patients respectively. The coagulation abnormalities were more prominent in cardiogenic in cardiogenic cerebral ischemia patients(p<0.05). In conclusion, because of the variable
effect
of
the inhibitors on currently available assay procedures, we recommend a battery of more than single test, including APA for the evaluation of lupus anticoagulant.
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KEYWORD
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