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Antiphospholipids


At a Glance

Why Get Tested?

To help investigate the presence of blood clots or an unexpectedly prolonged PTT (partial thromboplastin time), especially if you have had recurrent miscarriages; as part of an evaluation for antiphospholipid syndrome (APS); sometimes to help diagnose or evaluate an autoimmune disorder

When to Get Tested?

When you have an unexplained prolonged PTT test; when you have had recurrent unexplained blood clots; when you have had recurrent miscarriages, especially in the second and third trimesters

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

None

The Test Sample

What is being tested?

Antiphospholipid antibodies are a group of immune proteins (antibodies) that the body mistakenly produces against itself in an autoimmune response to phospholipids. Tests can detect these autoantibodies that bind to phospholipids and, in a way that is not well understood, increase the risk of excessive blood clotting.

Several tests are available, including:

  • Cardiolipin antibodies (anticardiolipin antibodies)
  • Lupus anticoagulant assays, these include activated partial thromboplastin time (aPTT), dRVVT (dilute Russell viper venom time), kaolin (or silica) clotting time, and PTT mixing tests
  • Beta-2 glycoprotein 1 antibodies

Phospholipids are structural components of cell membranes and play a crucial role in blood clotting. Phospholipds are critical to platelet function in addition to various coagulation co-factors. When antiphospholipid antibodies are produced, they interfere with the clotting process. They increase an affected person's risk of developing recurrent inappropriate blood clots (thrombi) in arteries and veins, which can lead to strokes, heart attacks, and/or miscarriages.

Antiphospholipid antibodies are also associated with low platelet counts (thrombocytopenia) and with the risk of recurrent miscarriages (especially in the second and third trimester), premature labor, and pre-eclampsia.

One or more antiphospholipid antibodies have been identified in various conditions. Some examples are:

Autoimmune disorders

  • Lupus
  • Rheumatoid arthritis
  • Systemic sclerosis

Infections

  • HIV
  • Mononucleosis
  • Rubella

Cancers

  • Solid tumors (colon, lung, etc.)
  • Leukemias
  • Lymphomas

Use of certain drugs

  • Procainamide
  • Phenothiazines
  • Oral contraceptives

The presence of phospholipid antibodies in some instances may be temporary and they have been identified in some individuals who have no detectable illnesses.

Antiphospholipid syndrome (APS), also called Hughes syndrome, is a recognized group of signs and symptoms that includes the formation of blood clots, miscarriages, platelet deficiency (thrombocytopenia), and the presence of one or more antiphospholipid antibodies. APS can be primary with no underlying autoimmune disorder or secondary, existing with a diagnosed autoimmune disorder.

The 14th International Congress on Antiphospholipid Antibodies Task Force criteria for identifying APS requires testing for cardiolipin antibodies, lupus anticoagulant, and beta-2 glycoprotein antibodies when one of two clinical problems exist, blood clots (thrombosis) or pregnancy morbidity.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

The Test

How is it used?

Antiphospholipid antibody testing is used to help determine the cause of:

  • Inappropriate blood clot formation (unexplained thrombotic episode, excessive clotting)
  • Recurrent miscarriage
  • Low platelet count (thrombocytopenia)
  • Prolonged PTT test

Depending on a person's signs and symptoms and medical history, a healthcare practitioner may order one or more of these tests to help detect the presence of antiphospholipid antibodies and/or to help diagnose antiphospholipid syndrome (APS):

  • Cardiolipin antibodies (IgG, IgM, and sometimes IgA) are frequently ordered since they are the most common antiphospholipid antibodies.
  • Lupus anticoagulant assays (e.g., RVVT, LA-sensitive PTT) if a person has a prolonged PTT test.
  • Beta-2 glycoprotein 1 testing may be ordered along with the other antiphospholipid antibodies to detect their presence and to provide the healthcare practitioner with additional information.

If an antiphospholipid antibody is detected, the same test(s) may be repeated 12 weeks later to determine whether their presence is persistent or temporary.

Testing may also be performed to help diagnose and/or evaluate a person with an autoimmune disorder, which can occur along with disorders like lupus. If a person with an autoimmune disorder tests negative for antiphospholipid antibodies, testing may be repeated to determine if an antibody has developed in the course of the disease.

When is it ordered?

This testing may be ordered when a person has signs and symptoms suggestive of a blood clot (thrombotic episode), such as pain and swelling in the extremities, shortness of breath, and headaches. It also may be ordered when a woman has had recurrent miscarriages and/or as a follow-up to a prolonged PTT test.

When one of the tests is positive, it may be repeated several weeks later to determine whether the antibody is temporary or persistent. Antiphospholipid testing may be done when clinical signs suggest the presence of antiphospholipid syndrome.

When a person with a diagnosed autoimmune disorder tests negative for antiphospholipid antibodies, one or more of the tests may be repeated at regular intervals to screen for the development of an antiphospholipid antibody.

What does the test result mean?

Care must be taken when interpreting the results of antiphospholipid antibody tests. A negative result means only that the specific antibody tested was not present at the time of the test.

Low to moderate levels of one or more antibodies may occur temporarily due to an infection or drug or may appear as a person ages. These levels are often not considered significant but must be examined in conjunction with a person's symptoms and other clinical information.

In some cases, a person may have one or more immunoglobulin classes of a specific antibody present or absent. For instance, the person may have significant quantities of IgG and IgM cardiolipin antibodies or may only be positive for the less frequently tested IgA cardiolipin antibody.

Moderate to high levels of one or more antiphospholipid antibodies, which persist when tested again 12 weeks later, indicate the likely continued presence of that specific antibody.

If tests indicate the presence of the lupus anticoagulant and it persists when retested, then it is likely that the person is positive for the lupus anticoagulant. People who have one or more antiphospholipid antibodies and those that are diagnosed with antiphospholipid syndrome can have an increased risk of having recurrent blood clots, recurrent miscarriages, and/or low platelets (thrombocytopenia).

Test results cannot predict the likelihood of complications, the type, or the severity in a particular person. Some people will have a variety of recurrent problems while others may never experience any difficulties. Examples of this include an asymptomatic individual who is diagnosed with antiphospholipid antibodies following a prolonged PTT test that is done for another reason (such as a pre-surgical screen) and an asymptomatic elderly person who has developed an antiphospholipid antibody.

Transient antiphospholipid antibodies may be seen in people who have inflammation, autoimmune disorders, infections, or cancer.

Is there anything else I should know?

Occasionally, antiphospholipid antibody testing may be ordered to help determine the cause of a positive VDRL/RPR test for syphilis. The reagents used to test for syphilis contain phospholipids and can cause a false-positive result in those with antiphospholipid antibodies.

False-positive test results may be seen in people who take drugs such as quinidine, procainamide, phenytoin, and penicillin.



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