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Lupus anticoagulant mixing tests for multiple reagents are more sensitive if
interpreted with a mixing test-specific cut-off than index of circulating
anticoagulant
#MMPMID30046711
Kumano O
; Moore GW
Res Pract Thromb Haemost
2018[Jan]; 2
(1
): 105-113
PMID30046711
show ga
BACKGROUND: Lupus anticoagulant (LA) is classified in the antibody family that is
recognized as antiphospholipid antibodies. Guidelines for LA detection recommend
mixing test interpretation with either a mixing test specific cut-off (MTC) or
index of circulating anticoagulant (ICA). We previously evidenced that MTC was
superior to ICA in detecting the in vitro inhibition of LA with a single dilute
APTT (activated partial thromboplastin time) and dRVVT (diluted Russell's viper
venom time) pairing. OBJECTIVES: The objective in the present study was to
compare the LA diagnostic effectiveness of MTC and ICA by multiple APTT and dRVVT
reagents. METHODS: One hundred-five samples from non-anticoagulated patients
positive for LA in the dilute APTT (dAPTT) and dRVVT reagent pairing employed for
diagnostic examination were performed by undiluted and in a 1:1 mix with normal
pooled plasma with four additional APTT reagents and another dRVVT reagent (dRVVT
B). RESULTS: Frequencies of MTC and ICA positivity were determined from samples
LA positive in undiluted plasma. MTC positivity in mixing test were 63%, 77%,
80%, 84%, 46%, 81%, and 72% in 4 APTT, dAPTT and 2 dRVVT, respectively. ICA
positivity were 47%, 67%, 58%, 54%, 42%, 47%, and 29%, respectively. There were
no samples of ICA-positive/MTC-negative with any reagent. CONCLUSIONS: The data
indicate that MTC is superior to ICA for LA detection in mixing tests in multiple
reagents and reagent types. Although mixing tests may make weak LA samples appear
negative, the efficacy of LA detection can be improved by the method to interpret
the results.