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Thromb Haemost 1984; 52(02): 172-175
DOI: 10.1055/s-0038-1661166
Original Article
Schattauer GmbH Stuttgart

The Diagnosis of Lupus Anticoagulants by the Activated Partial Thromboplastin Time - The Central Role of Phosphatidyl Serine

P R Kelsey
The U. K. Reference Laboratory for Anticoagulant Reagents and Control, Wlthlngton Hospital, Manchester, U. K.
,
K J Stevenson
The U. K. Reference Laboratory for Anticoagulant Reagents and Control, Wlthlngton Hospital, Manchester, U. K.
,
L Poller
The U. K. Reference Laboratory for Anticoagulant Reagents and Control, Wlthlngton Hospital, Manchester, U. K.
› Author Affiliations
Further Information

Publication History

Received 10 February 1984

Accepted 07 July 1984

Publication Date:
19 July 2018 (online)

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Summary

Liposomes of pure phospholipids were used in a modified APTT test system and the role of phosphatidyl serine (PS) in determining the sensitivity of the test system to the presence of lupus anticoagulants was assessed. Six consecutive patients with lupus anticoagulants and seven haemophiliacs with anticoagulants directed at specific coagulation factors, were studied. Increasing the concentration of phospholipid in the test system markedly reduced the sensitivity to lupus anticoagulants but had marginal effect on the specific factor inhibitors. The same effect was achieved when the content of PS alone was increased in a vehicle liposome of constant composition.

The results suggest that the lupus anticoagulants can best be detected by a screening method using an APTT test with a reagent of low PS content. The use of a reagent rich in PS will largely abolish the lupus anticoagulant’s effect on the APTT. An approach using the two different types of reagent may facilitate differentiation of lupus inhibitors from other types of anticoagulant.

Keywords

Lupus anticoagulant - Activated partial thromboplastin time phospholipid - Phosphatidyl serine
 

  • References

  • 1 Bowie EJ, Thompson Jr JH, Pascuzzi CA, Owen Jr CA. Thrombosis in systemic lupus erythematosis despite circulating anti-coagulants. J Lab Clin Med 1963; 62: 416-430
    PubMedGoogle Scholar
  • 2 Mueh JR, Herbst KD, Rapaport SI. Thrombosis in patients with the lupus anticoagulant. Ann Intern Med 1980; 92: 156-159
    CrossrefPubMedGoogle Scholar
  • 3 Boey ML, Colaco CB, Gharani AE, Elkon KB, Loizou S, Hughes GR. Thrombosis in SLE: Striking association with the presence of circulating lupus anticoagulant. Br Med J 1983; 287: 1021-1023
    CrossrefPubMedGoogle Scholar
  • 4 Schleider MA, Nachman RK, Jaffe EA, Coleman M. A clinical study of the lupus anticoagulant. Blood 1976; 48: 499-509
    PubMedGoogle Scholar
  • 5 Exner T, Rickard KA, Kroninberg H. A sensitive test demonstrating lupus anticoagulant and its behavioural patterns. Br J Haematol 1978; 40: 143-151
    CrossrefPubMedGoogle Scholar
  • 6 Triplett DA, Brandt JT, Kaczor D, Schaeffer J. Laboratory diagnosis of lupus inhibitors: A comparison of the tissue thromboplastin inhibition test with a new platelet neutralisation procedure. Am J Clin Pathol 1983; 79: 678-682
    CrossrefPubMedGoogle Scholar
  • 7 Coots MC, Miller MA, Glueck HI. The lupus inhibitor: A study of its heterogeneity. Thromb Haemostas 1981; 46: 734-739
    PubMedGoogle Scholar
  • 8 Firkin BG, Booth P, Hendrix L, Howard MA. Demonstration of a platelet bypass mechanism in the clotting system using an acquired anticoagulant. Am J Haematol 1978; 5: 81-82
    CrossrefPubMedGoogle Scholar
  • 9 Clyne LP, Dainaik N, Hoffman R, Hardin J. In vitro correction of anticoagulant activity and specific clotting factor assays in SLE. Thromb Res 1980; 18: 643-655
    CrossrefPubMedGoogle Scholar
  • 10 Veltkamp JJ, Kerhoven P, Loeliger EA. Circulating anticoagulant in disseminated lupus erythematosis. Haemostasis 1973; 2: 253-259
    PubMedGoogle Scholar
  • 11 Stevenson KJ, Easton AC, Thomson JM, Poller L. Lipid class composition and heparin sensitivity in the activated partial thromboplastin time. Thromb Haemostas 1983; 50: 601-603
    PubMedGoogle Scholar
  • 12 Stevenson KJ, Poller L. The procoagulant activity of partial thromboplastin extracts: the role of phosphatidyl serine. Thromb Res 1982; 41: 350-353
    PubMedGoogle Scholar
  • 13 Thomson JM. A practical guide to blood coagulation and haemostasis. Churchill; London: 1970
    Google Scholar
  • 14 Thomson JM. Blood coagulation and haemostasis: A practical guide. Churchill Livingstone; Edinburgh: 1980
    Google Scholar
  • 15 Exner T, Richard KA, Kronenburg H. Studies on phospholipids in the action of lupus coagulation inhibitor. Pathology 1975; 7: 319-328
    CrossrefPubMedGoogle Scholar
  • 16 Thiagarajan P, Shapiro SS. Lupus anticoagulants. Methods in haematology 7. Disorders of thrombin formation. Churchill Livingstone; Edinburgh: 1983. pp 101-108
    Google Scholar
  • 17 Lafer EM, Rauch J, Andrzejewski Jr C. et al Polyspecific monoclonal lupus autoantibodies reactive with both polynucleotides and phos-pholipids. J Exp Med 1981; 153: 897-909
    CrossrefPubMedGoogle Scholar
  • 18 Thiagarajan P, Shapiro SS, De Marco L. Monoclonal immunoglobulin M coagulation inhibitor with phospholipid specifity. J Clin Invest 1980; 66: 397-405
    CrossrefPubMedGoogle Scholar
  • 19 Zwaal RF A. Membrane and lipid involvement in blood coagulation. Biochim Biophys Acta 1978; 515: 163-205
    CrossrefPubMedGoogle Scholar
  • 20 Mannucci PM, Canciani MT, Mari D, Meucci P. The varied sensitivity of partial thromboplastin time reagents in the demonstration of the lupus-like anticoagulant. Scand J Haematol 1979; 22: 423-432
    PubMedGoogle Scholar