Lupus anticoagulant
Lupus anticoagulant | |
---|---|
Other names | Lupus antibody, LA, LAC, lupus inhibitors |
Lupus anticoagulant is an
The condition was first described by hematologist C. Lockard Conley in 1952.[2][3]
Terminology
Both words in the term "lupus anticoagulant" can be misleading:
- Most patients with a lupus anticoagulant do not actually have lupus erythematosus, and only a small proportion will proceed to develop this disease (which causes joint pains, skin problems and kidney failure, amongst other complications). People with lupus erythematosus are more likely to develop a lupus anticoagulant than the general population.
- The term "anticoagulant" accurately describes its function procoagulant.[4]
Indications for testing
The main indication for testing for lupus anticoagulant is a suspected
In a suspected antiphospholipid syndrome, lupus anticoagulant is generally tested in conjunction with anti-apolipoprotein antibodies and anti-cardiolipin antibodies, and diagnostic criteria require one clinical event (i.e. thrombosis or pregnancy complication) and two positive blood test results spaced at least three months apart that detect at least one of the three types of antibodies.[6]
Testing for lupus anticoagulant can also be indicated by a prolonged aPTT test that is unexplained.[5]
Workup
An
A
However, only about 60 per cent of patients with lupus anticoagulants have a both a prolonged APTT and APTT mix, making it unsuitable as the only test in case of a high suspicion of the antiphospholipid syndrome.[8] Thus, one or more of the following tests are generally performed to detect lupus anticoagulant if a high suspicion remains, and/or specify lupus anticoagulant as the cause of an abnormal mixing test:
- Phospholipid-sensitive functional clotting testing, such as the dilute Russell's viper venom time, or the Kaolin clotting time. As a further confirmation, a second test with the addition of excess phospholipid will correct the prolongation (conceptually known as "phospholipid neutralization"), confirming the diagnosis of a lupus anticoagulant.
- Lupus-sensitive aPTT, of which many variants exist, but have the common feature of having a greater sensitivity of becoming prolonged in the presence of lupus anticoagulant compared to a regular aPTT.[9]
- Hexagonal (II) phase phospholipid neutralization, wherein such phospholipids specifically neutralize lupus anticoagulant, so a normalization of aPTT after adding it specifically indicates the presence lupus anticoagulants.[10]
Treatment
Treatment for a lupus anticoagulant is usually undertaken in the context of documented
Miscarriages may be more prevalent in patients with a lupus anticoagulant. Some of these miscarriages may potentially be prevented with the administration of aspirin and unfractionated heparin. The Cochrane Database of Systematic Reviews provide a deeper understanding on the subject.[12]
Thrombosis is treated with
References
- ISBN 978-3-540-29541-9. Retrieved 29 June 2010.
- PMID 14938435.
- ^ "Lock Conley looks back and blushes". Hopkins Medicine. Spring–Summer 2006. Archived from the original on 21 June 2013. Retrieved 5 December 2013.
- ^ "wustl.edu". Archived from the original on 2008-08-21. Retrieved 2009-02-17.
- ^ a b "Lupus Anticoagulant Testing". Lab Tests Online. 6 December 2019. Last reviewed on August 22, 2018. This article was last modified on December 6, 2019.
- ^ "APS | Action". apsaction.org. Archived from the original on 2013-07-25. Retrieved 2013-11-06.
- S2CID 74865864.
- OCLC 64401294.
- PMID 7607585.
- S2CID 35046350.)
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: CS1 maint: multiple names: authors list (link - PMID 1782567.
- PMID 15846641. Archived from the original (PDF) on March 7, 2012 – via the World Health Organization.
- PMID 16769056.