TY - JOUR
T1 - Antiphospholipid antibody testing for the antiphospholipid syndrome
T2 - a comprehensive practical review including a synopsis of challenges and recent guidelines
AU - Favaloro, Emmanuel J
AU - Wong, Richard C W
PY - 2014/10
Y1 - 2014/10
N2 - The antiphospholipid (antibody) syndrome (APS) is an autoimmune condition characterised by a wide range of clinical features, but primarily identified as thrombotic and/or obstetric related adverse events. APS is associated with the presence of antiphospholipid antibodies (aPL), including the so-called lupus anticoagulant (LA). These aPL are heterogeneous in nature, detected with varying sensitivity and specificity by a diverse range of laboratory tests. All these tests are unfortunately imperfect, suffer from poor assay reproducibility (inter-method and inter-laboratory) and a lack of standardisation and harmonisation. Clinicians and laboratory personnel may struggle to keep abreast of these factors, as well as the expanding range of available aPL tests, and consequent result interpretation. Therefore, APS remains a significant diagnostic challenge for many clinicians across a wide range of clinical specialities, due to these issues related to laboratory testing as well as the ever-expanding range of reported clinical manifestations. This review is primarily focussed on issues related to laboratory testing for APS in regards to the currently available assays, and summarises recent international consensus guidelines for aPL testing, both for the liquid phase functional LA assays and the solid phase assays (anticardiolipin and anti-beta-2-Glycoprotein-I).
AB - The antiphospholipid (antibody) syndrome (APS) is an autoimmune condition characterised by a wide range of clinical features, but primarily identified as thrombotic and/or obstetric related adverse events. APS is associated with the presence of antiphospholipid antibodies (aPL), including the so-called lupus anticoagulant (LA). These aPL are heterogeneous in nature, detected with varying sensitivity and specificity by a diverse range of laboratory tests. All these tests are unfortunately imperfect, suffer from poor assay reproducibility (inter-method and inter-laboratory) and a lack of standardisation and harmonisation. Clinicians and laboratory personnel may struggle to keep abreast of these factors, as well as the expanding range of available aPL tests, and consequent result interpretation. Therefore, APS remains a significant diagnostic challenge for many clinicians across a wide range of clinical specialities, due to these issues related to laboratory testing as well as the ever-expanding range of reported clinical manifestations. This review is primarily focussed on issues related to laboratory testing for APS in regards to the currently available assays, and summarises recent international consensus guidelines for aPL testing, both for the liquid phase functional LA assays and the solid phase assays (anticardiolipin and anti-beta-2-Glycoprotein-I).
KW - Algorithms
KW - Antibodies, Anticardiolipin/analysis
KW - Antibodies, Antiphospholipid/analysis
KW - Antiphospholipid Syndrome/classification
KW - Clinical Laboratory Techniques
KW - Female
KW - Guidelines as Topic
KW - Humans
KW - Immunologic Factors/analysis
KW - Lupus Coagulation Inhibitor/analysis
KW - Pregnancy
KW - Reproducibility of Results
KW - Sensitivity and Specificity
KW - Thrombosis/diagnosis
KW - beta 2-Glycoprotein I/analysis
U2 - 10.1097/PAT.0000000000000142
DO - 10.1097/PAT.0000000000000142
M3 - Review article
C2 - 25158812
SN - 0031-3025
VL - 46
SP - 481
EP - 495
JO - Pathology
JF - Pathology
IS - 6
ER -