Verification of the guidelines for lupus anticoagulant detection: usefulness of index for circulating anticoagulant in APTT mixing test
Abstract
Introduction Lupus anticoagulant (LA) is an antibody that interferes with one or more in vitro coagulation reactions, which are dependent on interactions with protein-phospholipid complexes. For LA diagnosis, a mixing test is considered useful for differentiating the inhibitor from a factor deficiency. However, the usefulness and the index of circulating anticoagulant (ICA) in a mixing test with activated partial thromboplastin time (APTT) has not been adequately investigated, and there is scant information regarding the effects of warfarin, heparin, and hemophilia plasma on ICA. We evaluated the usefulness of ICA by investigating the correlation of that index with international normalized ratio (INR), heparin concentration, and factor VIII activity in hemophilia patients.Materials and methods We examined samples from 28 patients positive for LA, 23 receiving warfarin, 19 receiving unfractionated heparin, and 29 with hemophilia A, as well as 61 normal samples. APTT-SLA, Actin FSL, APTT-SP, and PTT-LA were used as reagents in this study.Results The correlation coefficient values between ICA and INR, heparin concentration, and factor VIII activity ranged from 0.031-0.342, 0.764-0.843, and 0.564-0.754, respectively, with the 4 reagents. The ICA values for the LA-positive samples were significantly higher than for the normal, warfarin, heparin, and hemophilia samples with all APTT reagents. Samples with a high heparin concentration above approximately 0.5U/ml showed ICA values greater than 15.Conclusion ICA was able to distinguish LA-positive samples from the normal, warfarin, and hemophilia samples, but not heparin samples. ICA calculated from APTT clotting time is useful for LA diagnosis.
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Cut-off values for screen, confirm, and mixing test in each additional reagent were determined from upper limits of the distribution of 50 normal samples in each reagent.
“Cut‐off values for screen, confirm, and mixing test in each additional reagent were determined from upper limits of the distribution of 50 normal samples in each reagent, and for ICA with the routinely employed LA reagents, ICA cut‐off values were previously established and used in each additional reagent.9, 21, 22, 23”
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- Authors
- Kumano, O., Ieko, M., Naito, S., Yoshida, M., Takahashi, N., Suzuki, T., & Aoki, T.
- Affiliations
- Health Sciences University of Hokkaido (JP)
- Corresponding author
- Ieko, Masahiro
- Venue
- Thrombosis Research
- Publisher
- Elsevier BV
- Published
- 2014-08
- Volume
- 134
- Issue
- 2
- Pages
- 503-509
- ISSN
- 0049-3848 (ISSN-L)
- OpenAlex
- W2085509869
- Semantic Scholar
- ead26863ccb1d380f7c1d53435b8ed7425d444f5
- Cited by
- 15
- References
- 29
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 1 · 2022: 2 · 2019: 2 · 2017: 3 · 2016: 4
- FWCI
- 1.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thrombosis Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- H. Kanda, N. Matsuo and H. Yamaguchi in Sysmex Corporation
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Health Sciences › Medicine › Hematology › Hemophilia Treatment and Research
- Keywords
- lupus anticoagulant, activated partial thromboplastin time, mixing test, warfarin, unfractionated heparin, hemophilia A, factor VIII activity, international normalized ratio
- MeSH terms
- Anticoagulants, Factor VIII, Hemophilia A, Heparin, Humans, Immunoglobulins, Partial Thromboplastin Time, Sensitivity and Specificity, Warfarin, Lupus Coagulation Inhibitor, Antiphospholipid Syndrome, International Normalized Ratio
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