Clinical audit of antiphospholipid antibody testing in tertiary practice: towards improved relevance in thrombophilia investigations

Background:  The antiphospholipid syndrome (APS) is an autoimmune condition characterised by vascular thromboses and/or pregnancy morbidity. Diagnosis of APS typically requires laboratory evidence of antiphospholipid antibodies (aPL). Depending on their clinical presentation, affected individuals mi...

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Bibliographic Details
Published in:Internal medicine journal 2012-04, Vol.42 (4), p.427-434
Main Authors: Favaloro, E. J., Reben, R., Mohammed, S., Koutts, J.
Format: Article
Language:English
Subjects:
Antibodies, Anticardiolipin - blood
Antibodies, Antiphospholipid - blood
anticardiolipin antibodies
Anticoagulants
antiphospholipid antibodies
antiphospholipid antibody syndrome
antiphospholipid syndrome
Antiphospholipid Syndrome - diagnosis
Antiphospholipid Syndrome - immunology
Autoantibodies
Autoimmune diseases
cardiolipin
Clinical Audit
Female
Hospitals
Humans
lupus anticoagulant
Male
Morbidity
Obstetrics
Pregnancy
Retrospective Studies
Systemic lupus erythematosus
thrombophilia
Thrombophilia - diagnosis
Thrombophilia - immunology
thromboplastin
Thrombosis
Vasculitis
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Summary:Background:  The antiphospholipid syndrome (APS) is an autoimmune condition characterised by vascular thromboses and/or pregnancy morbidity. Diagnosis of APS typically requires laboratory evidence of antiphospholipid antibodies (aPL). Depending on their clinical presentation, affected individuals might be seen by a variety of clinical specialities. Aim:  To evaluate clinical ordering patterns for aPL/APS at a tertiary level public facility. Methods:  We performed an audit of internal clinical requests for aPL tests at our institution for a 6‐month period. Results:  We identified a wide variety of clinical ordering background for aPL, of predominantly obstetric (72/268; 26.9%) or thrombophilic (78/268; 29.1%) patients. Only 11/268 samples (4.1%) were positive for lupus anticoagulant (LA) and 14/268 (5.2%) were positive for anticardiolipin antibody (aCL). The percentage of aCL positivity in the LA‐positive group was 46% (5/11). None of the 72 obstetric patients tested was identified to have aPL. Of the 11 LA‐positive patients, the reasons identified for testing comprised: prolonged Activated Partial Thromboplastin Time (assay) (n= 3), thrombosis (n= 3), APS (n= 2), systemic lupus erythematosus (n= 2), vasculitis (n= 1). Conclusion:  We determined a wide variety of clinical ordering background for aPL at a tertiary level institution, with an overall low rate (
ISSN:1444-0903
1445-5994
DOI:10.1111/j.1445-5994.2010.02329.x