APTT reagent with ellagic acid as activator shows adequate lupus anticoagulant sensitivity in comparison to silica‐based reagent
Open accessAbstract
Background Lupus anticoagulant (LA) is an antibody that interferes with phospholipid-dependent coagulation reactions. Activated partial thromboplastin time (APTT) is widely used as a test for LA screening. APTT reagents are composed of activators, such as silica or ellagic acid, and phospholipids, and APTT reagents with silica are recommended for LA screening because of greater sensitivity. However, the effects of activators on LA activity have not been adequately investigated.Objectives In this study, we examined whether an ellagic acid-based reagent was highly sensitive to LA in a low phospholipid condition and useful for LA screening.Methods Silica-based (SL) and ellagic acid-based (EA) reagents were prepared in-house with the same composition and concentration of phospholipids, while the commercial APTT reagents APTT-SLA (SLA), Actin FSL (FSL), APTT-SP (SP) and PTT-LA (PTT) were also included in the study.Results The normal reference ranges for SL and EA were 30.1-47.0 and 28.0-40.2 s, respectively, while the cut-off index values for circulating anticoagulant activity (ICA) calculated from the results obtained with SL, EA, SLA, FSL, SP and PTT were 12.9, 11.5, 13.2, 15.6, 14.3 and 14.0, respectively. The sensitivity of those reagents based on those cut-off values was 91%, 96%, 68%, 46%, 91% and 86%, respectively.Conclusions Our results showed that the ellagic acid-based reagent was more sensitive to LA than silica-based reagents in a low phospholipid condition and had adequate sensitivity to detect LA. We concluded that the sensitivity of APTT reagents for LA is dependent on phospholipid concentration and not the activator.
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The LA sensitivity of commercial APTT reagents depends on the combination of activator and phospholipid composition.
“LA sensitivity of commercial APTT reagents also depends on the combination of activator and PL composition.50”
Sensitivity and specificity of different APTT and dRVVT reagents to LA varies, predominantly due to differences in phospholipid composition and concentration.
“Sensitivity and specificity of different APTT and dRVVT reagents to LA varies, predominantly due to differences in phospholipid composition and concentration.10, 11, 12”
Differences in reagent composition and concentration of phospholipids between various types of reagents are considered to be the cause of interreagent variation in LA sensitivity.
“Differences in reagent composition and concentration of phospholipids between various types of reagents are considered to be the cause of interreagent variation in LA sensitivity [30,31].”
From Comparison of different algorithms for lupus anticoagulant detection: a single-center experience (2024) · cites this paper as [31]
The sensitivity of ellagic acid-based reagents to LA is comparable with that of other silica-based reagents.
“Although the sensitivity of ellagic acid-based reagents to LA is comparable with that of other silica-based reagents, the commercial reagents employed in this study are potentially less sensitive to LA [31].”
From Comparison of different algorithms for lupus anticoagulant detection: a single-center experience (2024) · cites this paper as [31]
The commercial reagents employed in this study are potentially less sensitive to LA.
“Although the sensitivity of ellagic acid-based reagents to LA is comparable with that of other silica-based reagents, the commercial reagents employed in this study are potentially less sensitive to LA [31].”
From Comparison of different algorithms for lupus anticoagulant detection: a single-center experience (2024) · cites this paper as [31]
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“22,25 CLSI 2014 deliberately avoids the use of “ LA-sensitive/LA-insensitive ” terminology, based on the concept that “ LA sensitivity ” is dif fi cult to appropriately de fi ne due to the lack of any “ gold standard ” LA detection method.”
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Comparison of different algorithms for lupus anticoagulant detection: a single-center experience
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- Authors
- KUMANO, O., IEKO, M., NAITO, S., YOSHIDA, M., & TAKAHASHI, N.
- Affiliations
- Health Sciences University of Hokkaido (JP)
- Corresponding author
- IEKO, M.
- Venue
- Journal of Thrombosis and Haemostasis
- Publisher
- Elsevier BV
- Published
- 2012-11
- Volume
- 10
- Issue
- 11
- Pages
- 2338-2343
- ISSN
- 1538-7836 (ISSN-L)
- OpenAlex
- W1801003996
- Cited by
- 59
- References
- 7
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 10 · 2023: 5 · 2022: 3 · 2021: 6 · 2020: 5 · 2019: 2 · 2018: 4 · 2017: 2 · 2016: 4 · 2015: 1 · 2014: 6 · 2013: 1
- FWCI
- 1.96
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thrombosis and Haemostasis (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Sysmex Corporation
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Keywords
- lupus anticoagulant, activated partial thromboplastin time, ellagic acid, reagent sensitivity, phospholipid content, anticoagulant screening
- MeSH terms
- Algorithms, Blood Coagulation, Ellagic Acid, Humans, Indicators and Reagents, Partial Thromboplastin Time, Phospholipids, Reference Values, Sensitivity and Specificity, Silicon Dioxide, Lupus Coagulation Inhibitor
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