Testing for the Lupus Anticoagulant

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The page below is a sample from the LabCE course Laboratory Evaluation of the Lupus Anticoagulant found in Antiphospholipid Syndrome (APS). Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

Learn more about Laboratory Evaluation of the Lupus Anticoagulant found in Antiphospholipid Syndrome (APS) (online CE course)
Testing for the Lupus Anticoagulant

Laboratory investigation of LA should begin with screening assays, including:
  • Prothrombin time (PT)
  • Activated partial thromboplastin time (aPTT)
  • Thrombin time (TT)
Performing these tests will help to screen for LA and provide information for additional testing that should be performed. Additionally, these screening tests can help to ensure the integrity of the patient sample. There is no specific testing for LA; however, the Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibody of the Scientific and Standardization Committee of the International Society on Thrombosis and Hemostasis has set up testing criteria:
  • Prolongation of at least one phospholipid-dependent clotting test (usually assay with low phospholipid content).
  • Evidence of inhibitory activity shown by the effect of patient plasma on pooled normal plasma (mixing studies).
  • Evidence that the inhibitory activity depends on phospholipids. This may be achieved by the addition or alteration of phospholipid, hexagonal phase phospholipid, platelets, or platelet vesicles in the test system.
  • LA must be carefully distinguished from other coagulopathies that may give similar laboratory results or may occur concurrently with LA. Specific factor assays or clinical history may be helpful in the differentiation of LA from other possibilities.
  • To exclude the presence of LA, at least two different screening assays need to be negative.
  • The presence of LA must be confirmed after at least 12 weeks, better after one year.