Similar Mechanism of Various Lupus Anticoagulants

Summary

Potent lupus inhibitors from various patients were mixed with platelet free normal plasma and were compared in activated partial thromboplastin time (APTT), dilute prothrombin time (dil. PT), kaolin clotting time (KCT), contact product clotting time (CPCT), and Russell viper venom clotting time (RWCT) tests. In the last three tests platelets and platelet lipid substitutes were avoided to enhance the sensitivities of these tests for the lupus anticoagulant. Correlations between the KCT and the other tests were mostly good, indicating that different lupus inhibitors functioned by a similar mechanism. There was no significant trend between particular clinical symptoms and individual coagulation test combinations. The KCT was found to be the most sensitive test for the lupus inhibitor, followed by the CPCT, RWCT, dil. PT and APTT tests. Activated platelets tended to correct the APTT lupus inhibitor defect in all except the strongest inhibitor cases.

Key words

Lupus inhibitors - Mechanism - Test sensitivity - Clinical associations

• References

• 1 Okpara RA, Carabello JA, Day HJ. Spurious prolongation of the activated partial thromboplastin time. Thromb Haemostas 1977; 38: 900-908
• 2 Duran-Suarez JR. Incidence of circulating anticoagulants in a normal population. Acta Haematol 1982; 67: 217-219
• 3 Feinstein DI, Rapaport SI. Acquired inhibitors of blood coagulation. Prog Haemostas 1972; 1: 75-95
• 4 Bowie EJ W, Thompson JH, Pascuzzi CA, Owen CA. Thrombosis in systemic lupus erythematosus despite circulating anticoagulant. J Lab Clin Med 1963; 62: 416-430
• 5 Boey ML, Colaco CB, Gharavi AE, Elkon KB, Loizou S, Hughes GR V. Thrombosis in systemic lupus erythematosus: striking association with the presence of lupus anticoagulant. Br Med J 1983; 287: 1021-1023
• 6 Hughes GR V. Thrombosis, abortion, cerebral disease and the lupus anticoagulant. Br Med J 1983; 287: 1088-1089
• 7 Schlieder MA, Nachman RL, Jaffe EA, Coleman MA. A clinical study of the lupus anticoagulant. Blood 1976; 48: 499-510
• 8 Exner T. Comparison of two simple tests for the lupus anticoagulant. Am J Clin Pathol. 1984 In press
• 9 Exner T, Rickard KA, Kronenberg H. A sensitive test demonstrating lupus anticoagulant and its behavioural patterns. Br J Haematol 1978; 40: 143-151
• 10 Tan EM, Cohen AS. et al The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982; 25: 1271-1277
• 11 Perez-Requejo JL, Ingram GI C. Preparation of “contact product” as a reagent for coagulation tests. J Clin Pathol 1975; 28: 596-599
• 12 Bell HG, Alton HG. A brain extract as a substitute for platelet suspensions in the thromboplastin generation test. Nature 1954; 174: 880-881
• 13 Margolis J. The kaolin clotting time. A rapid one stage method for diagnosis of coagulation defects J Clin Pathol 1958; 11: 406-409
• 14 Proctor RR, Rapaport SI. The partial thromboplastin time with kaolin. Am J Clin Pathol 1961; 36: 212-218
• 15 Walsh PN. Albumin density gradient separation and washing of platelets and the study of platelet coagulant activities. Br J Haematol 1972; 22: 205-208
• 16 Ingram GI C, Knights SF, Arocha-Pinango CL, Shepperd JP, Perez-Requejo JL. Simple screening tests for the diagnosis of isolated clotting factor defects. J Clin Pathol 1975; 28: 524-530
• 17 Biggs R. Human blood coagulation, Haemostasis and Thrombosis. Blackwell Scientific Publications Ltd; Oxford: 1983
• 18 Vercellotti GM, Mosher DF. Acquired factor XI deficiency in systemic lupus erythematosus. Thromb Haemostas 1982; 48: 250-252
• 19 Biggs R, Denson DW E. The mode of action of a coagulation inhibitor in the blood of two patients with disseminated lupus erythematosus. Br J Haematol 1964; 10: 198-216
• 20 Duran-Suarez JR. Anticoagulantes circulantes en el lupus critematoso sistemico. Medicina Clinica 1983; 81: 203-206
• 21 Castro O, Farber LR, Clyne LP. Circulating anticoagulants against factors IX and XI in systemic lupus erythematosus. Ann Int Med 1972; 77: 543-548
• 22 Shoenfeld Y, Rauch J. et al Polyspecificity of monoclonal lupus antibodies produced by human-human hybridomas. N Engl J Med 1982; 308: 414-420
• 23 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: 81-92
• 24 Triplett DA, Brandt JT, Kaczor D, Schaefer J. Laboratory diagnosis of lupus inhibitors: A comparison of the tissue thromboplastin inhibition procedure with a new platelet neutralization procedure. Am J Clin Pathol 1983; 79: 678-682