Antiphospholipid syndrome: laboratory testing and diagnostic strategies
#MMPMID22473619
Ortel TL
Am J Hematol
2012[May]; 87 Suppl 1
(Suppl 1
): S75-81
PMID22473619
show ga
The antiphospholipid syndrome (APS) is diagnosed in patients with recurrent
thromboembolic events and/or pregnancy loss in the presence of persistent
laboratory evidence for antiphospholipid antibodies. Diagnostic tests for the
detection of antiphospholipid antibodies include laboratory assays that detect
anticardiolipin antibodies, lupus anticoagulants, and anti-?(2)-glycoprotein I
antibodies. These assays have their origins beginning >60 years ago, with the
identification of the biologic false positive test for syphilis, the observation
of "circulating anticoagulants" in certain patients with systemic lupus
erythematosus, the identification of cardiolipin as a key component in the
serologic test for syphilis, and the recognition and characterization of a
"cofactor" for antibody binding to phospholipids. Although these assays have been
used clinically for many years, there are still problems with the accurate
diagnosis of patients with this syndrome. For example, lupus anticoagulant
testing can be difficult to interpret in patients receiving anticoagulant
therapy, but most patients with a thromboembolic event will already be
anticoagulated before the decision to perform the tests has been made. In
addition to understanding limitations of the assays, clinicians also need to be
aware of which patients should be tested and not obtain testing on patients
unlikely to have APS. New tests and diagnostic strategies are in various stages
of development and should help improve our ability to accurately diagnose this
important clinical disorder.
|Antibodies, Anticardiolipin/blood
[MESH]
|Anticoagulants/adverse effects/therapeutic use
[MESH]
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