Anti-cardiolipin and anti-β2-glycoprotein I antibodies: normal reference ranges in northwestern Italy
Abstract
Laboratory tests for anticardiolipin antibodies (aCL) and anti-β2glycoprotein I antibodies (a-β2GPI) face problems common to many autoantibody assays: the lack of a reference standard and the need for each laboratory to assess assay-specific cut-off values. The aims of the study were to evaluate the reference range upper limits (99th percentile) used for aCL and a-β2GPI in the northwest of Italy and to investigate the analytical performances of these assays with the newly obtained reference ranges. We assayed aCL and a-β2GPI in 104 serum samples from patients without a history of thrombosis, pregnancy morbidity, tumours, infections and/or autoimmune diseases (30 males and 74 non-pregnant females). We tested all the commercial assays available in our regions (i.e. Orgentec Diagnostika, Aesku Diagnostics and Inova Diagnostics ELISA; CliA Zenit-RA and EliA Phadia Laboratory Systems). A further 30 serum samples, including 10 from healthy subjects, 10 from antiphospholipid syndrome (APS) patients and 10 from septic patients were assessed to investigate the analytical performance of the obtained cut-off limits. Reference range upper limits obtained with the commercial kits differ among assays and from the values reported by the manufacturer. Moreover, normal reference ranges calculated for IgG and IgM aCL differed from the arbitrary selected laboratory classification values suggested in the guidelines of 40 GPL and MPL.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In-house calculated cutoff values may differ significantly from those recommended by manufacturers.
“In-house calculated cutoff values may be significantly different from those recommended by the manufacturers.[70][71][72]”
Cites
MIYAKIS, S., LOCKSHIN, M. D., ATSUMI, T., BRANCH, D. W., BREY, R. L., CERVERA, R., DERKSEN, R. H. W. M., DE GROOT, P. G., KOIKE, T., MERONI, P. L., et al. (2006) · Journal of Thrombosis and Haemostasis · doi:10.1111/j.1538-7836.2006.01753.x · Cited by 7,203 · see citing works
Pierangeli, S., de Groot, P. G., Dlott, J. S., Favaloro, E. J., Harris, E., Lakos, G., Ortel, T. L., Meroni, P. L., Otomo, K., Pengo, V., et al. (2011) · Lupus · doi:10.1177/0961203310395055 · Cited by 179 · see citing works
Multicenter Evaluation of Nine Commercial Kits for the Quantitation of Anticardiolipin Antibodies
Reber, G., Arvieux, J., Comby, E., Degenne, D., de Moerloose, P., Sanmarco, M., Potron, G., & On behalf of the working group on Methodologies in Haemostasis from the GEHT (Groupe d’Etudes sur I’Hémostase et la Thrombose), F. (1995) · Thrombosis and Haemostasis · doi:10.1055/s-0038-1653795 · Cited by 157 · see citing works
Reber, G., Arvieux, J., Comby, E., Degenne, D., de Moerloose, P., Sanmarco, M., & Potron, G. (1995) · PubMed · Cited by 147 · see citing works
Reber, G., Tincani, A., Sanmarco, M., de Moerloose, P., & Boffa, M. (2004) · Journal of Thrombosis and Haemostasis · doi:10.1111/j.1538-7836.2004.00910.x · Cited by 134 · see citing works
Antiphospholipid syndrome: laboratory detection, mechanisms of action and treatment
Tripodi, A., de Groot, P. G., & Pengo, V. (2011) · Journal of Internal Medicine · doi:10.1111/j.1365-2796.2011.02362.x · Cited by 113 · see citing works
Antiphospholipid antibodies — We are not quite there yet
Urbanus, R. T., & de Groot, P. G. (2011) · Blood Reviews · doi:10.1016/j.blre.2010.12.001 · Cited by 48 · see citing works
Consensus guidelines for anticardiolipin antibody testing
Wong, R. C. W. (2004) · Thrombosis Research · doi:10.1016/j.thromres.2004.06.002 · Cited by 40 · see citing works
European attempts for the standardisation of the antiphospholipid antibodies
Tincani, A., Filippini, M., Scarsi, M., Galli, M., & Meroni, P. L. (2009) · Lupus · doi:10.1177/0961203309106919 · Cited by 40 · see citing works
Favaloro, E. J., Wong, R. C. W., Silvestrini, R. A., McEvoy, R., Jovanovich, S., & Roberts-Thomson, P. J. (2005) · Seminars in Thrombosis and Hemostasis · doi:10.1055/s-2005-863808 · Cited by 39 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Devreese, K. M. J., de Groot, P. G., de Laat, B., Erkan, D., Favaloro, E. J., Mackie, I., Martinuzzo, M., Ortel, T. L., Pengo, V., Rand, J. H., et al. (2020) · Journal of Thrombosis and Haemostasis · doi:10.1111/jth.15047 · Cited by 439 · see citing works
Diagnosis and Management of the Antiphospholipid Syndrome
Ciavarella, A., & Martinelli, I. (2018) · New England Journal of Medicine · doi:10.1056/nejmc1808253 · Cited by 51 · see citing works
Distribution of antiphospholipid antibodies in a large population-based German cohort
Manukyan, D., Rossmann, H., Schulz, A., Zeller, T., Pfeiffer, N., Binder, H., Münzel, T. F., Beutel, M. E., Müller‐Calleja, N., Wild, P. S., et al. (2016) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm-2016-0014 · Cited by 35 · see citing works
Vanoverschelde, L., Kelchtermans, H., Musial, J., de Laat, B., & Devreese, K. M. J. (2019) · Research and Practice in Thrombosis and Haemostasis · doi:10.1002/rth2.12207 · Cited by 33 · see citing works
Montaruli, B., Luna, E. D., Erroi, L., Marchese, C. A., Mengozzi, G., Napoli, P., Nicolò, C., Romito, A., Bertero, M., Sivera, P., et al. (2016) · International Journal of Laboratory Hematology · doi:10.1111/ijlh.12466 · Cited by 25 · see citing works
Self-citationBor, M. V., Jacobsen, I.-L. S., Gram, J., & Sidelmann, J. J. (2018) · Lupus · doi:10.1177/0961203318776105 · Cited by 13 · see citing works
Willis, R., Pierangeli, S. S., Jaskowski, T. D., Malmberg, E. M., Guerra, M. M., Salmon, J. E., Petri, M., Branch, D. W., & Tebo, A. E. (2016) · American Journal of Clinical Pathology · doi:10.1093/ajcp/aqw065 · Cited by 11 · see citing works
Mattia, E., Ruffatti, A., Meneghel, L., Tonello, M., Faggian, D., Hoxha, A., Fedrigo, M., Punzi, L., & Plebani, M. (2015) · Clinica Chimica Acta · doi:10.1016/j.cca.2015.04.012 · Cited by 7 · see citing works
Lackner, K. J., & Müller‐Calleja, N. (2018) · Hämostaseologie · doi:10.1055/s-0038-1675355 · Cited by 6 · see citing works
Chen, Y., Chi, L., Chow, K., Chiou, S.-H., Fan, Y.-H., Ho, S.-P., Hsu, Y., Hwang, Y.-C., Wu, M.-X., Lee, W., et al. (2016) · BMC Veterinary Research · doi:10.1186/s12917-016-0727-3 · Cited by 3 · see citing works
Liu, C., Yan, L., Zhang, M., Gou, Y., Duan, Y., Liu, T., Jiang, Y., Peng, L., & Li, W. (2024) · Scientific Reports · doi:10.1038/s41598-024-71549-2 · Cited by 2 · see citing works
Castilla-Agudelo, G. A., Padilla, L. M. R., Velásquez, S., Zapata, L. J. H., Navas, M. A. M., Barreneche, M. F. Á., & Franco, C. J. V. (2024) · Revista Colombiana de Reumatología (English Edition) · doi:10.1016/j.rcreue.2022.01.003 · Cited by 1 · see citing works
Antiphospholipid antibodies in healthy Serbian middle-aged subjects: Preliminary data
Bećarević, M. B., Jovičić, S. Ž., Ignjatović, S., & Mirković, D. (2022) · Journal of Medical Biochemistry · doi:10.5937/jomb0-35642
Castilla-Agudelo, G. A., Padilla, L. M. R., Velásquez, S., Zapata, L. J. H., Navas, M. A. M., Barreneche, M. F. Á., & Franco, C. J. V. (2022) · Revista Colombiana de Reumatología · doi:10.1016/j.rcreu.2022.01.003
Determination of pediatric reference limits for 10 commonly measured autoantibodies
Sepiashvili, L., Bohn, M. K., Hall, A., Henderson, T., Chen, J., Dunst, R., & Adeli, K. (2022) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm-2022-0675
Bhaskaran, H., Mithun, C., Visalakshy, J., Surendran, S., Gayathri, S., Bhaskaran, R., Easwar, S. V., & Pradeep, M. (2026) · BMC Rheumatology · doi:10.1186/s41927-026-00636-w
- Authors
- Montaruli, B., De Luna, E., Mengozzi, G., Molinari, F., Napolitano, E., Napoli, P., Nicolo, C., Romito, A., Stella, S., Bazzan, M., Bertero, M., Carignola, R., & Marchese, C.
- Affiliations
- Regional Network for Rare Diseases. APS Piedmont Consortium, Italy
- GAL (Gruppo Autoimmunita’ di Laboratorio del Piemonte e della Valle d’Aosta), Italy
- Venue
- Lupus
- Publisher
- SAGE Publications
- Published
- 2012-05-25
- Volume
- 21
- Issue
- 7
- Pages
- 799-801
- ISSN
- 0961-2033 (ISSN-L)
- 1477-0962
- OpenAlex
- W2100567310
- Cited by
- 16
- References
- 10
- Citations by year
- 2026: 1 · 2024: 2 · 2022: 3 · 2020: 1 · 2019: 1 · 2018: 3 · 2016: 4 · 2015: 1
- FWCI
- 0.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Lupus (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Keywords
- anticardiolipin antibodies, anti-beta2-glycoprotein I antibodies, reference values, antiphospholipid syndrome, analytical performance, IgM and IgG antibodies, sepsis, thrombosis, commercial ELISA kits, northwestern Italy
- MeSH terms
- Adult, Aged, Autoantibodies, Female, Humans, Immunoglobulin G, Immunoglobulin M, Italy, Male, Middle Aged, Reference Values, Antibodies, Anticardiolipin, beta 2-Glycoprotein I, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review