Abstract
The Antiphospholipid Syndrome (APS) is classified based on the presence of both clinical and laboratory criteria. Both sets of criteria are subject to much review and intense research as it is becoming increasingly clear that no single test is specific for defining this autoimmune disorder. A number of leading international bodies have released guidelines in an attempt to improve the laboratory testing and reporting. The current review is an appraisal of some of the literature pertaining to the laboratory testing.
Similar content being viewed by others
References
Khamashta M, Hughes GRV (1999) Hughes syndrome: a short history of the antiphospholipid syndrome. In: Schoenfeld Y (ed) The decade of autoimmunity. Elsevier Science BV
Nayfe R, Uthman I, Aoun J, SaadAldin E, Merashli M, Khamashta MA (2013) Seronegative antiphospholipid syndrome. Rheumatology (Oxf Engl) 52:1358–1367
Meroni PL, Chighizola CB, Rovelli F, Gerosa M (2014) Antiphospholipid syndrome in 2014: more clinical manifestations, novel pathogenic players and emerging biomarkers. Arthritis Res Ther 16:1–14
Forastiero R (2012) Bleeding in the antiphospholipid syndrome. Hematology (Amst Neth) 17(Suppl 1):153–155
de Groot PG, Urbanus RT, Derksen RHWM (2012) Pathophysiology of thrombotic APS: Where do we stand? Lupus 21:704–707
Giannakopoulos B, Krilis SA (2013) The pathogenesis of the antiphospholipid syndrome. N Engl J Med 368:1033–1044
de Groot PG, Meijers JCM (2011) β(2)–Glycoprotein I: evolution, structure and function. J Thromb Haemost JTH 9:1275–1284
Krilis SA, Giannakopoulos B (2014) Laboratory methods to detect antiphospholipid antibodies. Hematol Am Soc Hematol Educ Program 2014:321–328
de Groot PG, Urbanus RT (2012) The significance of autoantibodies against β2-glycoprotein I. Blood 120:266–274
Lackner KJ, Müller-Calleja N (2016) Pathogenesis of the antiphospholipid syndrome revisited: time to challenge the dogma. J Thromb Haemost JTH 14:1117–1120
Wilson WA, Gharavi AE, Koike T, Lockshin MD, Branch DW, Piette JC et al (1999) International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. Arthritis Rheum 42:1309–1311
Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R et al (2006) International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost JTH 4:295–306
Cousins L, Pericleous C, Khamashta M, Bertolaccini ML, Ioannou Y, Giles I et al (2015) Antibodies to domain I of β-2-glycoprotein I and IgA antiphospholipid antibodies in patients with “seronegative” antiphospholipid syndrome. Ann Rheum Dis 74:317–319
Pengo V, Testa S, Martinelli I, Ghirarduzzi A, Legnani C, Gresele P et al (2015) Incidence of a first thromboembolic event in carriers of isolated lupus anticoagulant. Thromb Res 135:46–49
Pengo V, Ruffatti A, Legnani C, Testa S, Fierro T, Marongiu F et al (2011) Incidence of a first thromboembolic event in asymptomatic carriers of high-risk antiphospholipid antibody profile: a multicenter prospective study. Blood 118:4714–4718
Mustonen P, Lehtonen KV, Javela K, Puurunen M (2014) Persistent antiphospholipid antibody (aPL) in asymptomatic carriers as a risk factor for future thrombotic events: a nationwide prospective study. Lupus 23:1468–1476
de Groot PG, Lutters B, Derksen RHWM, Lisman T, Meijers JCM, Rosendaal FR (2005) Lupus anticoagulants and the risk of a first episode of deep venous thrombosis. J Thromb Haemost JTH 3:1993–1997
de Laat B, Derksen RHWM, Urbanus RT, de Groot PG (2005) IgG antibodies that recognize epitope Gly40-Arg43 in domain I of beta 2-glycoprotein I cause LAC, and their presence correlates strongly with thrombosis. Blood 105:1540–1545
Banzato A, Pozzi N, Frasson R, De Filippis V, Ruffatti A, Bison E et al (2011) Antibodies to domain I of β(2)Glycoprotein I are in close relation to patients risk categories in antiphospholipid syndrome (APS). Thromb Res 128:583–586
Pengo V, Banzato A, Denas G, Jose SP, Bison E, Hoxha A et al (2013) Correct laboratory approach to APS diagnosis and monitoring. Autoimmun Rev 12:832–834
Forastiero R (2014) Multiple antiphospholipid antibodies positivity and antiphospholipid syndrome criteria re-evaluation. Lupus 23:1252–1254
Park SH, Jang S, Park C-J, Chi H-S (2016) Clinical application of revised laboratory classification criteria for antiphospholipid antibody syndrome: Is the follow-up interval of 12 weeks instead of 6 weeks significantly useful? BioMed Res Int 2016:2641526
Pengo V, Denas G, Padayattil SJ, Zoppellaro G, Bison E, Banzato A et al (2015) Diagnosis and therapy of antiphospholipid syndrome. Pol Arch Med Wewn 125:672–677
Pengo V, Tripodi A, Reber G, Rand JH, Ortel TL, Galli M et al (2009) Update of the guidelines for lupus anticoagulant detection. Subcommittee on Lupus anticoagulant/antiphospholipid antibody of the Scientific and Standardisation Committee of the International Society on Thrombosis and Haemostasis. J Thromb Haemost JTH 7:1737–1740
Rand JH, Wolgast LR (2012) Dos and don’ts in diagnosing antiphospholipid syndrome. Hematol Am Soc Hematol Educ Program 2012:455–459
Devreese KMJ, Pierangeli SS, de Laat B, Tripodi A, Atsumi T, Ortel TL et al (2014) Testing for antiphospholipid antibodies with solid phase assays: guidance from the SSC of the ISTH. J Thromb Haemost 12:792–795
Keeling D, Mackie I, Moore GW, Greer IA, Greaves M (2012) British Committee for Standards in haematology. Guidelines on the investigation and management of antiphospholipid syndrome. Br J Haematol 157:47–58
Moore GW (2014) Recent guidelines and recommendations for laboratory detection of lupus anticoagulants. Semin Thromb Hemost 40(2):163–171
De Craemer AS, Musial J, Devreese KM (2016) Role of anti-domain 1-β2 glycoprotein I antibodies in the diagnosis and risk stratification of antiphospholipid syndrome. J Thromb Haemost 14(9):1779–1787. doi:10.1111/jth.13389
Simmons DP, Herskovits AZ, Battinelli EM, Schur PH, Lemire SJ, Dorfman DM (2016) Lupus anticoagulant testing using two parallel methods detects additional cases and predicts persistent positivity. Clin Chem Lab Med. doi:10.1515/cclm-2015-0790. pii: /j/cclm.ahead-of-print/cclm-2015-0790/cclm-2015-0790.xml
Ahluwalia J, Sreedharanunni S, Kumar N, Masih J, Bose SK, Varma N et al (2016) Thrombotic primary antiphospholipid syndrome: the profile of antibody positivity in patients from North India. Int J Rheum Dis 19(9):903–912
Meneghel L, Ruffatti A, Gavasso S, Tonello M, Mattia E, Spiezia L et al (2015) The clinical performance of a chemiluminescent immunoassay in detecting anti-cardiolipin and anti-β2 glycoprotein I antibodies. A comparison with a homemade ELISA method. Clin Chem Lab Med 53:1083–1089
Oku K, Amengual O, Kato M, Bohgaki T, Horita T, Yasuda S et al (2016) Significance of fully automated tests for the diagnosis of antiphospholipid syndrome. Thromb Res 146:1–6
Sciascia S, Sanna G, Murru V, Roccatello D, Khamashta MA, Bertolaccini ML (2015) The global anti-phospholipid syndrome score in primary APS. Rheumatology (Oxf Engl) 54:134–138
Sciascia S, Sanna G, Murru V, Roccatello D, Khamashta MA, Bertolaccini ML (2013) GAPSS: the Global Anti-Phospholipid Syndrome Score. Rheumatology (Oxf Engl) 52:1397–1403
Sciascia S, Cuadrado MJ, Sanna G, Murru V, Roccatello D, Khamashta MA et al (2014) Thrombotic risk assessment in systemic lupus erythematosus: validation of the global antiphospholipid syndrome score in a prospective cohort. Arthritis Care Res 66:1915–1920
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Dr Jasmina Ahluwalia and Dr Sreejesh Sreedharanunni have no conflict of interest to declare.
Ethical Approval
This article does not contain any studies with human participants performed by any of the authors. This article does not contain any studies with animals performed by any of the authors.
Rights and permissions
About this article
Cite this article
Ahluwalia, J., Sreedharanunni, S. The Laboratory Diagnosis of the Antiphospholipid Syndrome. Indian J Hematol Blood Transfus 33, 8–14 (2017). https://doi.org/10.1007/s12288-016-0739-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12288-016-0739-y