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Kaolin clotting time and dilute Russell's viper venom time distinguish
between prothrombin-dependent and beta 2-glycoprotein I-dependent
antiphospholipid antibodies
M Galli, G Finazzi, EM Bevers and T Barbui
Department of Hematology, Ospedali Riuniti, Bergamo, Italy.
Antiphospholipid (aPL) antibodies include anticardiolipin (aCL) and lupus
anticoagulant (LA) antibodies. LA antibodies recognize the complex of
lipid-bound (human) prothrombin, in this way inhibiting the
phospholipid-dependent coagulation reactions, whereas aCL antibodies are
directed towards beta 2-glycoprotein I (beta 2-GPI) bound to an anionic
lipid surface. According to their behavior in coagulation reactions, we
have divided aCL antibodies into two groups: aCL-type A, which inhibit the
phospholipid-dependent coagulation reactions because they enhance the
binding of beta 2-GPI to the procoagulant phospholipid surface; and
aCL-type B antibodies, which are devoid of anticoagulant properties. We
report the distinctive laboratory and clinical profiles of 25 patients with
well-characterized, phospholipid-dependent inhibitor of coagulation.
Fourteen patients had LA antibodies (aCL-type B were concomitantly present
in 10 cases, while in the other four, aCL titer was normal), and the other
11 had aCL-type A antibodies. The laboratory evaluation of the two groups
showed the dilute Russell viper venom time (dRVVT) to be the most abnormal
coagulation test in the aCL- type A-positive group, whereas the kaolin
clotting time (KCT) was the most abnormal assay in the LA-positive group.
In fact, the ratios of the coagulation times of patient plasma over normal
pooled plasma (mean +/- standard deviation) for LA versus aCL-type A
antibodies were 1.48 +/- 0.27 versus 2.20 +/- 0.42, P = .0001, and 2.22 +/-
0.42 versus 1.50 +/- 0.42, P = .0003, for the dRVVT and KCT, respectively.
No differences were observed either in the ratios of the activated partial
thromboplastin times and the prothrombin times or the plasma levels of beta
2-GPI and prothrombin. Conversely, aCL titers were significantly higher in
aCL-type A-positive patients (147 +/- 44 U) than in the LA- positive group
(61 +/- 55 U; P = .0003). We ruled out the possibility that platelet
contamination of plasma could account for the observed coagulation
profiles, as the two patterns were reproduced in platelet- free plasma. In
addition, we performed clotting tests in plasma in the presence of
phospholipids and calcium after addition of factor IXa or factor Xa. The
assay performed with factor Xa was more sensitive to the presence of
aCL-type A antibodies, while the assay performed with factor IXa was
preferentially sensitive to LA-containing plasmas, supporting the earlier
findings with the dRVVT and KCT assays.(ABSTRACT TRUNCATED AT 400 WORDS)
Volume 86,
Issue 2,
pp. 617-623,
07/15/1995
Copyright © 1995 by The American Society of Hematology
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