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Laboratory diagnosis and management challenges in the antiphospholipid syndrome

Lupus Research Unit, The Rayne Institute, King’s College London School of Medicine at Guy’s, King’s and St Thomas’ Hospitals, St Thomas’ Hospital, London, UK, maria.bertolaccini{at}kcl.ac.uk

M A Khamashta

Lupus Research Unit, The Rayne Institute, King’s College London School of Medicine at Guy’s, King’s and St Thomas’ Hospitals, St Thomas’ Hospital, London, UK

The antiphospholipid syndrome (APS) is characterized by recurrent arterial and/or venous thrombosis and pregnancy morbidity manifested by early or late losses. Laboratory diagnosis of APS relies on the demonstration of a positive test for antiphospholipid antibodies (aPL). In clinical practice, the gold standard tests are those that detect anticardiolipin antibodies (aCL) and/or the lupus anticoagulant (LA). Although other specificities for aPL have been described their clinical utility and standardization has still to be established. Persistence of aPL positive tests must be demonstrated, and other causes and underlying factors considered. Although it is universally recognized that the routine screening tests (aCL and/or LA) might miss some cases, careful differential diagnosis and repeat testing are mandatory before the diagnosis of ‘seronegative APS’ can be made. Correct identification of patients with APS is important, because prophylactic anticoagulant therapy can prevent thrombosis from recurring, and treatment of affected women during pregnancy can improve fetal and maternal outcome.

Key Words: anticardiolipin • heparin • lupus anticoagulant • pregnancy morbidity • thrombosis • warfarin

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