Lupus anticoagulants: improved diagnosis with a kaolin clotting time using rabbit brain phospholipid in standard and high concentrations

Rosove, Michael H.; Ismail, Mohammad K.; Koziol, Brian J.; Runge, Alice; Kasper, Carol K.

doi:10.1182/blood.v68.2.472.472

Cited by 73 publications

(12 citation statements)

References 29 publications

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“…The result of the direct Coombs test was positive and PAIgG was 128.9 ng/10 7 platelets. At this time, lupus anticoagulant, determined by the method of Rosove et al [8], was positive, but anti-cardiolipin antibody, determined by the solid phase enzyme immunoassay of Koike et al [9], was negative. Serum protein concentration and electrophoretic profiles were normal; however, monoclonal gammopathy (IgG, ) was observed.…”

Section: Casementioning

confidence: 98%

“…The prothrombin time was normal, but the activated partial thromboplastin time was prolonged. Lupus anticoagulant was determined by the method of Rosove et al [8] and there was a false-positive result on the serologic test for syphilis. Results of the test for anticardiolipin antibody, performed by the solid phase enzyme immunoassay of Koike et al [9], were positive for IgM but negative for IgG.…”

Section: Casementioning

confidence: 99%

“…In addition, lupus anticoagulant was detected in two of our patients and cardiolipin antibody in one. Lupus anticoagulant, which induces a prolongation of phospholipid-dependent clotting times such as prothrombin time and partial thromboplastin time, has been found in patients with systemic lupus erythematosus (SLE) [8,9]. Ciaudo et al [20] reported four cases of primary lymphoplasmacytic lymphoma of the spleen associated with lupus anticoagulant and monoclonal IgM.…”

Section: Our Patientsmentioning

confidence: 99%

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Immunological abnormalities in splenic marginal zone cell lymphoma

et al. 1997

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The clinical features of patients with splenic marginal zone cell lymphoma (SMZCL) have rarely been reported. In the present study, immunological abnormalities, particularly hematological abnormalities, observed in SMZCL were described. Autoimmune hemolytic anemia, immune thrombocytopenia, and appearance of lupus anticoagulant were observed in 2 of 3 patients with SMZCL. Other abnormal data including monoclonal gammopathy and cold agglutinin were also observed in 2 of the 3 patients. Immunological abnormalities may be characteristic complications in patients with SMZCL and must be followed carefully, since they may be a reliable marker of this type of lymphoma activity.

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Section: Casementioning

confidence: 98%

Section: Casementioning

confidence: 99%

Section: Our Patientsmentioning

confidence: 99%

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Immunological abnormalities in splenic marginal zone cell lymphoma

et al. 1997

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“…In the absence of a specific diagnostic test, various assays have been developed for the diagnosis of LAs. The assays are based on two basic principles and differ in their simplicity, sensitivity and specificity: (a) prolongation of coagulation in the presence of diluted phospholipid: tissue thromboplastin inhibition test (TTI) (3), kaolin clotting time (KCT) of platelet-poor plasma (16-18), dilute Russell viper venom time (19): (b) shortening of clotting time with excess of phospholipid: platelet neutralization procedure (PNP) (20), KCT with standard and high concentrations of phospholipid (21). During the years 1984-1987 all patients in our institution with a prolonged activated partial thromboplastin test (APTT), which fulfilled the criteria for LAs (4), were evaluated by the TTIratio, PNP and KCT-index.…”

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confidence: 99%

Clinical manifestations and laboratory findings in patients with lupus anticoagulants

Kornberg

Silber

Yona

et al. 1989

European J of Haematology

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Clinical and laboratory features were evaluated in 48 patients with lupus anticoagulants and the efficiency of three different assays in the detection of lupus anticoagulants was compared. The diagnosis of lupus anticoagulants was based on a prolonged activated partial thromboplastin test not corrected in a mixture of 1:1 with normal plasma and lack of specific inhibitors against coagulation factors. Platelet neutralization procedure was positive for lupus anticoagulants in 98% of the patients, tissue thromboplastin inhibition ratio in 79%, and kaolin clotting time index in 77%. At least one of the assays was positive in 100% of the cases. The largest minority of the patients (31%) suffered from systemic lupus erythematosus. The others had a variety of non‐immunological disorders. In the 13 patients who had been operated on, only 1 with renal failure developed hemorrhagic complications after renal biopsy due to thrombocytopathy. The incidence of recurrent spontaneous miscarriage, immune thrombocytopenia and positive direct antiglobulin test, anti‐nuclear and anti‐DNA antibodies and VDRL was significantly higher in patients with lupus anticoagulants and systemic lupus erythematosus compared to patients with lupus anticoagulants but without systemic lupus erythematosus.

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Letter to the editor: Sensitivities of lupus anticoagulant assays

1989

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Lo et al evaluated the sensitivities of various lupus anticoagulant assays [ I ] , including the system we developed, the rabbit brain neutralization procedure (RBNP) [2], referred to by Lo et al. as the StdiHigh-PC APTT. The RBNP is a kaolin-activated partial thromboplastin time system employing a commercially available rabbit brain phospholipid (Platelin, General Diagnostics) in which clotting time ratios employing onefold standard and fourfold-increased lupus anticoagulant-"neutralizing" phospholipid concentrations are generated, and the difference (onefold minus fourfold) calculated.The data upon which Lo et al. declared that the RBNP is insensitive require reinterpretation. The problem stems from the fact that we had a category of "indeterminate" test results. In our original description, we required of a positive test that the difference between ratios exceed the mean + 2 SD of normal subjects (ratio difference 20.17) und that the fourfold clotting time ratio fall to within the normal range. We have since dropped the latter requirement because it reduces test sensitivity for two reasons: 1 ) we have observed patients with lupus anticoagulants and no other coagulation disturbance whose fourfold ratios do not completely normalize, as Lo ct al. observed, and 2) the fourfold ratio may not normalize when there is a coexisting coagulation disturbance, for example, due to warfarin therapy. We used to apply the term "indeterminate" to describe such results. Lo et al. have suggested that "indeterminate" is not a useful classification, and we agree. Elimination of this category of results does not alter any of the conclusions in our original publication. We now simply express RBNP results as a ratio difference and classify them either as positive (20.17) or negative (<0. 17).In their testing of 18 undiluted APTT inhibitor plasma.\, Lo et al. found the ratio differences in the RBNP to exceed 0.17 in all cases, but because they considered their eight "indeterminate" results to be negative, they calculated a sensitivity of 10118. Had they considered the "indeterminate" results positive, as discussed above, then 181 I8 plasmas were positive.As a separate issue, we are concerned that Lo et al. made specific recommendations concerning which lupus anticoagulant assays should be utilized in routine hospital practice based on analysis of only 18 samples. Calculated from the binomial distribution, the 95% confidence limits for a test scoring 18/18 is fairly broad (81.5-100%), overlapping the confidence limits of a test scoring, for example, 1311 8 (46.5-90.3540). A two-sided Fisher's exact test to determine whether the sensitivities of two tests scoring 13/18 and 18/18 are equal is of borderline significance ( P = 0.045). When account is taken of the many pairwise comparisons possible in analysis of a sizeable group of tests, a P value considerably lower than 0.05 is desirable for declaring the significance of any given pair comparison. Lo et al. found that 9/10 assays (including the RBNP) yielded positive results in 13/18 to...

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Lupus anticoagulants: improved diagnosis with a kaolin clotting time using rabbit brain phospholipid in standard and high concentrations

Cited by 73 publications

References 29 publications

Immunological abnormalities in splenic marginal zone cell lymphoma

Immunological abnormalities in splenic marginal zone cell lymphoma

Clinical manifestations and laboratory findings in patients with lupus anticoagulants

Letter to the editor: Sensitivities of lupus anticoagulant assays

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