Laboratory Evaluation of the Lupus Anticoagulant found in Antiphospholipid Syndrome (APS)

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Donna D. Castellone, MS, MASCP MT(ASCP)SH
Reviewer: Andrea Gordon, M.Ed., MT(ASCP) SH(ASCP); Laurie Bjerklie, MA, MLS(ASCP)CM

This course discusses the characteristics of the antiphospholipid syndrome (APS) and its relationship to the lupus anticoagulant (LA) while identifying the clinical implications of LA. Specimen collection and handling of specimens used in testing for LA is covered. From a laboratory testing standpoint, algorithms and recommended guidelines for lupus testing are included along with the principles of the laboratory testing used to identify the LA. Lastly, treatment modalities for persons with LA are discussed.

Continuing Education Credits

Objectives

  • Discuss the characteristics of the antiphospholipid syndrome (APS) and its relationship to the lupus anticoagulant (LA).
  • Identify the clinical implications of LA.
  • List specimen collection and handling requirements for lupus testing.
  • Identify testing algorithms and recommended guidelines for lupus testing.
  • Describe the principles of the laboratory testing used to identify LA.
  • Discuss treatment modalities in patients with LA.

Course Outline

  • Introduction
      • Introduction to the Lupus Anticoagulant (LA)
      • Antiphospholipid Syndrome
      • Lupus Anticoagulant
      • Patients who present with lupus anticoagulant (LA) have a prolonged clotting time and are prone to bleeding.
      • Clinical Manifestations of Systemic Lupus Erythematosus
      • Clinical Manifestations of Systemic Lupus Erythematosus, continued
      • Clinical and Laboratory Criteria for the Diagnosis of APS
      • What are the criteria needed to make a diagnosis of antiphospholipid syndrome (APS)?
      • Bleeding Complications in Patients with SLE
  • Preanalytical Variables and Specimen Processing
      • Specimen Collection for Lupus Anticoagulant Testing
      • Platelet Poor Plasma
      • It is important to work with platelet-poor plasma (PPP) when testing for a lupus anticoagulant (LA). What impact does the presence of platelets have o...
  • Testing
      • Testing for the Lupus Anticoagulant
      • Screening with the Activated Partial Thromboplastin Time (aPTT)
      • An aPTT reagent is considered sensitive if it has a decreased concentration of phospholipids.
      • Thrombin Time (TT) and Reptilase Time
      • Heparin Neutralization
      • Mixing Study
      • A patient that presents with an LA will have a mixing study that corrects.
      • Dilute Russell Viper Venom Time (dRVVT)
      • Hexagonal Phase Neutralization
      • What is the addition of normal plasma to the hexagonal phase neutralization test used to rule out?
      • Other Assays: Clotting Tests
      • Other Tests: Enzyme-Linked Immunosorbent Assay (ELISA)
      • Testing Guidelines
      • Interference in LA Testing
  • Treatment
      • Patient Treatment
  • Conclusion
      • Conclusion
  • References
      • References

Additional Information

Level of instruction: Intermediate
 
Intended Audience: Medical laboratory scientists, medical technologists, and technicians. This course is also appropriate for medical laboratory science students, pathology residents, and other healthcare personnel who are responsible for prescribing and administering antiplatelet and anticoagulant medications.
 
Author Information: Donna D. Castellone, MS, MACSP, MT(ASCP)SH, is the Quality Manager for the Specialty Laboratory and the Supervisor of the Special Coagulation Laboratory at Columbia Medical Center New York Presbyterian Hospital in New York. She has a Master's Degree in Health Science. Donna has published over 100 articles and written chapters in five books. Additionally, Ms. Castellone has over 35 years of experience in Hematology and Coagulation.
 
Reviewer Information: Andrea G. Gordon, M.Ed, MT(ASCP)SH, has over 25 years of experience as a Program Director for various laboratory science programs. She has approximately 5 years of experience as an administrator in higher education as a VP and Director of Education. Additionally, she has over 15 years of experience as a volunteer for NAACLS.
 
Review Information: Laurie Bjerklie, M.A., MLS(ASCP)CM is currently a Content Developer for MediaLab and LabCE. She earned a B.S. in Medical Laboratory Science from the University of North Dakota and an M.A. in Curriculum and Instruction from Saint Xavier University. She has over 15 years of experience in higher education and has held faculty positions in both MLT and MLS programs. She most recently served as the Program Manager of Medical Laboratory Science at Saint Louis University.

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