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Lupus anticoagulants: improved diagnosis with a kaolin clotting time using
rabbit brain phospholipid in standard and high concentrations
MH Rosove, M Ismail, BJ Koziol, A Runge and CK Kasper
We utilized a kaolin-activated partial thromboplastin time (APTT) using
rabbit brain phospholipid, in which the capacity of a fourfold increased
"high" phospholipid concentration (PC) to normalize the abnormal "standard"
PC-APTT in patients with lupus anticoagulants is assessed. This system was
also used to measure factors VIIIC, IX, and XI. The tissue thromboplastin
inhibition test (TTI), a prothrombin time system in which the activity of a
lupus anticoagulant is unmasked by the use of dilute thromboplastin, was
simultaneously evaluated. Test sensitivity was defined by results on 31
consecutive patients with standard PC-APTT inhibitors and no bleeding
tendency. Specificity was based on 94 patients with various other
coagulopathies, including coagulation factor inhibitors, severe congenital
factor deficiencies, hepatic insufficiency, and warfarin and heparin
treatment. Twenty-one patients with lupus erythematosus and standard
PC-APTT results within normal limits were also tested. Sensitivity of the
APTT system was superior to that of the TTI (97% v 58%); high PC normalized
clotting time ratios and factor levels. Positive results were common with
both assays in the group of 20 heparinized patients. The APTT system had
superior specificity in remaining cases; there were no positive tests among
74 patients. The lupus erythematosus group had a significant decrease in
the clotting time ratio with high PC, indicating that low- level lupus
anticoagulants are quite prevalent in this group. The kaolin clotting time
using rabbit brain phospholipid in standard and high concentrations is a
simple, sensitive, and specific technique for diagnosis of lupus
anticoagulants.
Volume 68,
Issue 2,
pp. 472-478,
08/01/1986
Copyright © 1986 by The American Society of Hematology
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