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Item Value
ClinicalQuestion Does my patient have antiphospholipid syndrome (APLS)?
TestEntryNumber 27
TestCode APLA
TestName Anti-Phospholipid Antibody Panel
Synonyms LA; Lupus anticoagulant; antiphospholipid syndrome
IsThisScreeningTest It depends
PubMedID 18755986, 16420554, 12393574, 22951216
Comment The diagnosis of anti-phospholipid syndrome requires clinical and laboratory evidence (full criteria listed in the revised Sapporo criteria, J Thromb Haemost. 2006;4(2):295). The laboratory evaluation should take place at least 12 weeks after a qualifying clinical event and be repeated at least 12 weeks after the first round of tests. We do not recommend testing for anti-phospholipid syndrome at the time of an acute event. The anti-phospholipid antibody panel includes the most important laboratory tests in this definition: Anti-beta-2-glycoprotein and anti-cardiolipin, IgG and IgM, and two tests for a lupus anticoagulant (Russel's viper venom and a PTT-based hexogonal phospholipid neutralization). The presence of clinical criteria and at least one positive laboratory criteria (with repeat positivity at least 12 weeks apart) establishes a diagnosis of anti-phospholipid syndrome. The battery of tests is very sensitive on initial testing.

Studies that linked anti-phopholipid antibodies and lupus anticoagulants to thrombosis showed varying degrees of association with respect to the various anti-bodies. Presence of a lupus anticoagulant demonstrated the single strongest association. Anti-cardiolipin and anti-beta-2-glycoprotein were more predictive of thrombosis when they were of the IgG type and in high titers. The strongest association was seen when multiple tests were positive. One study suggests prognostic data may be gleaned from the laboratory data: persistently elevated titers of anti-cardiolipin may be a risk factor for thrombotic recurrence in patient's with anti-phospholipid syndrome.

Transient elevation in both anti-cardiolipin IgG and IgM titers occur, frequently in infections. These false positives are more frequent with anti-cardiolipin than anti-beta-2-glycoprotein.

Testing for lupus anticoagulant in the presence of anticoagulant therapy (including warfarin, direct thrombin inhibitors & direct factor 10a inhibitors, and supratherapeutic heparin) is not recommended due to possible interference with test results. The presence of factor deficiencies or a factor specific inhibitor may also interfere with this assay. Clinical correlation is advised.
Sensitivity NA
Specificity NA
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