Clinical significance of the mixing test in laboratory diagnoses of lupus anticoagulant
Abstract
The mixing test is used to determine the presence of inhibitors in laboratory diagnoses of lupus anticoagulant. Updated international guidelines state that an integrated lupus anticoagulant test system does not require the mixing test; an appraisal of the mixing tests in integrated lupus anticoagulant test systems is, therefore, required. We investigated the clinical relevance of mixing tests by using the best cutoff value of the mixing test through thrombotic risk analysis. A retrospective analysis was performed on 525 specimens with positive screening tests by using two integrated lupus anticoagulant tests: diluted Russell's Viper venom (dRVVT) and silica clotting time. The diagnostic performance of two interpretation formulas (percentage correction, Rosner index) was assessed, and the thrombotic risk of a subgroup based on the mixing results was investigated. Finally, the thrombotic risk of lupus anticoagulant positivity based on the integrated lupus anticoagulant test system procedures was assessed for the appraisal of mixing test exclusion in integrated lupus anticoagulant test systems. The best cutoff values of mixing test interpretation methods based on dRVVT were as follows: 60.1% for percentage correction and 15.7 for Rosner index. There was no substantial difference in the thrombotic risk between percentage correction and the Rosner index. The mixing-positive group showed a higher lupus anticoagulant titer and higher thrombotic risk than the mixing-negative group. H…
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The mixing of weak LA samples may introduce loss of detectable LA activity and false-negativity give rise to inaccurate interpretation if the mixing test result is employed as a decision point for subsequent confirmatory test performance.
“The mixing of weak LA samples may introduce loss of detectable LA activity and the false‐negativity give rise to inaccurate interpretation if the mixing test result is employed as a decision point for subsequent confirmatory test performance.14, 31, 32, 33”
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“29,50,51,62,63 Detection of weaker LAs is a particular advantage of this approach, where the prolongation of a patient ’ s basal clotting time is insuf fi cient to exceed the upper reference limit of a screening test, yet the screen and con fi rm discrepancy reveals the antibody.”
BackgroundInfluentialMixing studies in lupus anticoagulant testing are required at least in some type of samples
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- Authors
- Hong, S. K., Hwang, S. M., Kim, J.-E., & Kim, H. K.
- Affiliations
- Seoul National University (KR)
- Corresponding author
- Kim, Ji-Eun
- Kim, Hyun Kyung
- Venue
- Blood Coagulation & Fibrinolysis
- Published
- 2012-12
- Volume
- 23
- Issue
- 8
- Pages
- 739-744
- ISSN
- 0957-5235 (ISSN-L)
- OpenAlex
- W2331915197
- Cited by
- 22
- References
- 16
- Citations by year
- 2025: 1 · 2023: 2 · 2022: 3 · 2017: 5 · 2016: 2 · 2015: 2 · 2014: 3 · 2013: 4
- FWCI
- 1.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Blood Coagulation & Fibrinolysis (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- lupus anticoagulant, mixing test, thrombosis risk, diagnostic thresholds
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Partial Thromboplastin Time, Predictive Value of Tests, Prothrombin Time, Retrospective Studies, Risk Factors, Thrombosis, Lupus Coagulation Inhibitor, Antiphospholipid Syndrome, Practice Guidelines as Topic
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