Abstract
The updated international consensus criteria for definite antiphospholipid syndrome (APS) are useful for scientific clinical studies. However, there remains a need for diagnostic criteria for routine clinical use. We audited the results of routine antiphospholipid antibodies (aPLs) in a cohort of 193 consecutive patients with aPL positivity-based testing for lupus anticoagulant (LA), IgG and IgM anticardiolipin (aCL) and anti-ß2glycoprotein-1 antibodies (aß2GPI). Medium/high-titre aCL/aβ2GPI was defined as >99th percentile. Low-titre aCL/aβ2GPI positivity (>95th < 99th percentile) was considered positive for obstetric but not for thrombotic APS. One hundred of the 145 patients fulfilled both clinical and laboratory criteria for definite APS. Twenty-six women with purely obstetric APS had persistent low-titre aCL and/or aβ2GPI. With the inclusion of these patients, 126 of the 145 patients were considered to have APS. Sixty-seven out of 126 patients were LA-negative, of whom 12 had aCL only, 37 had aβ2GPI only and 18 positive were for both. The omission of aCL or aβ2GPI testing from investigation of APS would have led to a failure to diagnose APS in 9.5% and 29.4% of patients, respectively. Our data suggest that LA, aCL and aβ2GPI testing are all required for the accurate diagnosis of APS and that low-titre antibodies should be included in the diagnosis of obstetric APS.
Highlights
The antiphospholipid syndrome (APS) is characterized by thrombotic and/or pregnancy morbidity associated with the presence of persistent antiphospholipid antibodies.[1]
We report the clinical and laboratory findings of a cohort of 193 patients who had persistently positive tests for aPL
One hundred of these 193 patients had APS as defined by Sydney clinical as well as laboratory criteria[1]; and 126 when women with purely obstetric APS associated with low-titre aCL and/or ab2GPI were included as suggested in a number of other studies[7,9,10,17] not included in the Sydney laboratory criteria for APS.[1]
Summary
The antiphospholipid syndrome (APS) is characterized by thrombotic and/or pregnancy morbidity associated with the presence of persistent antiphospholipid antibodies (aPLs).[1]. >40 GPL or MPL or >99th percentile), and/or anti-b2glycoprotein-1 (ab2GPI) (IgG and/or IgM) >99th percentile. The updated international consensus (Sydney) classification (ICS) criteria for definite antiphospholipid syndrome[1] require the presence of a lupus anticoagulant (LA) and/or IgG or IgM anticardiolipin antibodies (aCL) present in medium or high titre These aPL should be persistent, defined as being present on two or more consecutive occasions at least 12 weeks. The international consensus criteria were originally designed for scientific clinical studies and were never intended for diagnostic use. There remains a need for firm diagnostic criteria for routine clinical use, which may differ from these
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