Chapter 117 : Laboratory Testing for Antibodies Associated with Antiphospholipid Antibody Syndrome

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Preview this chapter:
Zoom in

Laboratory Testing for Antibodies Associated with Antiphospholipid Antibody Syndrome, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555815905/9781555813642_Chap117-1.gif /docserver/preview/fulltext/10.1128/9781555815905/9781555813642_Chap117-2.gif


Of the several types of antiphospholipid antibodies (aPL) described, lupus anticoagulant (LA) antibodies and anticardiolipin antibodies (aCL) are the types most clearly associated with antiphospholipid antibody syndrome (APS), the latter being the focus of this chapter. The Venereal Disease Research Laboratory (VDRL) and rapid plasma reagin tests were then developed, both employing purified cardiolipin combined with cholesterol and lecithin as the antigen. Classification of patients with APS considers both clinical and laboratory criteria. The syndrome is classified as primary APS when not associated with another disease and accounts for over 50% of cases. The first category of aPL, LA antibodies, are detected with certain phospholipid-dependent coagulation assays. Definite APS is present when at least one clinical criterion and one laboratory criterion are present. LAs are antibodies that are prothrombotic in vivo but display anticoagulant properties in vitro (i.e., they prolong certain coagulation tests). Antibodies associated with APS that are detected in aCL ELISAs were originally thought to bind to the phospholipid molecule. An appreciation of the presence of aPL in systemic lupus erythematosus (SLE) patients, and their association with thrombosis, led to the development of an RIA for detection of aCL antibodies and subsequently an ELISA-based format. As discussed in the chapter, cutoff levels should be validated in each laboratory performing aPL testing. Alternative phospholipids and/or cofactor antibodies may be detected in patients with APS. Occasional patients with APS do not have aCL, LA, or β2GPI antibodies.

Citation: Schmitz J. 2006. Laboratory Testing for Antibodies Associated with Antiphospholipid Antibody Syndrome, p 1046-1052. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch117
Highlighted Text: Show | Hide
Loading full text...

Full text loading...


1. Abuaf, N.,, S. Laperche,, B. Rajoely,, R. Carsique,, A. Deschamps,, A. M. Rouquette,, C. Barthet,, Z. Khaled,, C. Marbot,, N. Saab,, J. Rozen,, P. M. Girard, and , W. Rozenbaum. 1997. Autoantibodies to phospholipids and to the coagulation proteins in AIDS. Thromb. Haemost. 77: 856861.
2. Alarcón-Segovia, D.,, M. C. Boffa,, W. Branch,, R. Cevera,, D. Gharavi,, M. Kharmashta,, Y. Shoenfeld,, W. Wilson, and , R. Roubey. 2003. Prophylaxis of the antiphospholipid syndrome: a consensus report. Lupus 12: 499503.
3. Arnout, J.,, C. Wittevrongel,, M. Vanrusselt,, M. Hoylaerts, and , J. Vermylen. 1998. Beta-2-glycoprotein I dependent lupus anticoagulants form stable bivalent antibody beta-2-glycoprotein I complexes on phospholipid surfaces. Thromb. Haemost. 79: 7986.
4. Arvieux, J.,, L. Darnige,, C. Caron,, G. Reber,, J. C. Bensa, and , M. G. Colomb. 1995. Development of an ELISA for autoantibodies to prothrombin showing their prevalence in patients with lupus anticoagulants. Thromb. Haemost. 74: 11201125.
5. Asherson, R.,, R. Cervera,, J. C. Piette,, J. Font,, J. T. Lie,, A. Burcoglu,, K. Lim,, F. J. Munoz-Rodriguez,, R. A. Levy,, F. Boue,, J. Rossert, and , M. Ingelmo. 1998. Catastrophic antiphospholipid syndrome: clinical and laboratory features of 50 patients. Medicine (Baltimore) 77: 195207.
6. Audrain, M. A.,, F. Colonna,, F. Morio,, M. A. Hamidou, and , J. Y. Muller. 2004. Comparison of different kits in the detection of autoantibodies to cardiolipin and beta2glyco-protein 1. Rheumatology (Oxford) 43: 181185.
7. Bas de Laat, H.,, R. H. Derksen, and , P. G. de Groot. 2004. Beta2-glycoprotein I, the playmaker of the antiphospholipid syndrome. Clin. Immunol. 112: 161168.
8. Bevers, E. M.,, M. Galli,, T. Barbui,, P. Comfurius, and , R. E. Zwaal. 1991. Lupus anticoagulant IgG’s (LA) are not directed to phospholipids only, but to a complex of lipid-bound human prothrombin. Thromb. Haemost. 66: 629632.
9. Brandt, J. T.,, L. K. Barna, and , D. A. Triplett. 1995. Laboratory identification of lupus anticoagulants: results of the Second International Workshop for Identification of Lupus Anticoagulants. On behalf of the Subcommittee on Lupus Anticoagulants/Antiphospholipid Antibodies of the ISTH. Thromb. Haemost. 74: 15971603.
10. Brandt, J. T.,, D. A. Triplett,, B. Alving, and , I. Scharrer. 1995. Criteria for the diagnosis of lupus anticoagulants: an update. On behalf of the Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibody of the Scientific and Standardisation Committee of the ISTH. Thromb. Haemost. 74: 11851190.
11. Carreras, L.,, R. Forastiero, and , M. Martinuzzo. 2000. Which are the best biological markers of the antiphospholipid syndrome? J. Autoimmun. 15: 163172.
12. Cervera, R., and , R. A. Asherson. 2003. Clinical and epi-demiological aspects in the antiphospholipid syndrome. Immunobiology 207: 511.
13. Cervera, R.,, J. C. Piette,, J. Font,, M. Khamashta,, Y. Shoenfeld,, M. T. Camps,, S. Jacobsen,, G. Lakos,, A. Tincani,, I. Kontopoulou-Griva,, M. Galeazzi,, P. Meroni,, R. Derksen,, P. G. de Groot,, E. Gromnica-Ihle,, M. Baleva,, M. Mosca,, S. Bombardieri,, F. Houssiau,, J. C. Gris,, I. Quere,, E. Hachulla,, C. Vasconcelos,, B. Roch,, A. Fernandez Nebro,, M. C. Boffa,, G. Hughes, and , M. Ingelmo. 2002. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1000 patients. Arthritis Rheum. 46: 10191027.
14. Chamley, L. W. 1997. Antiphospholipid antibodies or not? The role of beta 2 glycoprotein 1 in autoantibody-mediated pregnancy loss. J. Reprod. Immunol. 36: 123142.
15. Chandramouli, N. B., and , G. M. Rodgers. 2001. Management of thrombosis in women with antiphospholipid syndrome. Clin. Obstet. Gynecol. 44: 3647.
16. Constans, J.,, V. Guerin,, A. Couchouron,, M. Seigneur,, A. Ryman,, A. D. Blann,, J. Amiral,, A. Amara,, E. Peuchant,, J. F. Moreau,, I. Pellegrin,, J. L. Fellegrin,, H. Fleury,, B. Leng, and , C. Conri. 1998. Autoantibodies directed against phospholipids or human beta 2-glycoprotein I in HIV-seropositive patients: relationship with endothelial activation and antimalonic dialdehyde antibodies. Eur. J. Clin. Investig. 28: 115122.
17. Cucurull, E.,, A. E. Gharavi,, E. Diri,, E. Mendez,, D. Kapoor, and , L. R. Espinoza. 1999. IgA anticardiolipin and anti-beta2-glycoprotein I are the most prevalent iso-types in African American patients with systemic lupus ery-thematosus. Am. J. Med. Sci. 318: 5560.
18. Day, H. M.,, P. Thiagarajan,, C. Ahn,, J. D. Reveille,, K. F. Tinker, and , F. C. Arnett. 1998. Autoantibodies to beta2-glycoprotein I in systemic lupus erythematosus and primary antiphospholipid antibody syndrome: clinical correlations in comparison with other antiphospholipid antibody tests. J. Rheumatol. 25: 667674.
19. de Larranaga, G. F.,, R. R. Forastiero,, L. O. Carreras, and , B. S. Alonso. 1999. Different types of antiphospholipid antibodies in AIDS: a comparison with syphilis and the antiphospholipid syndrome. Thromb. Res. 96: 1925.
20. de Larranaga, G. F.,, R. R. Forastiero,, M. E. Martinuzzo,, L. O. Carreras,, G. Tsariktsian,, M. M. Sturno, and , B. S. Alonso. 2000. High prevalence of antiphospholipid antibodies in leprosy: evaluation of antigen reactivity. Lupus 9: 594600.
21. de Moerloose, P.,, G. Reber, and , J. J. Vogel. 1990. Anticardiolipin antibody determination: comparison of three ELISA assays. Clin. Exp. Rheumatol. 8: 575577.
22. Derksen, R. H., and , P. G. de Groot. 2004. Clinical consequences of antiphospholipid antibodies. Neth. J. Med. 62: 273278.
23. Derksen, R. H.,, P. Hasselaar,, L. Blokzijl,, E. H. Gmelig Meyling, and , P. G. De Groot. 1988. Coagulation screen is more specific than the anticardiolipin antibody ELISA in defining a thrombotic subset of lupus patients. Ann. Rheum. Dis. 47: 364371.
24. Facer, C. A., and , G. Agiostratidou. 1994. High levels of anti-phospholipid antibodies in uncomplicated and severe Plasmodium falciparum and in V. vivax malaria. Clin. Exp. Immunol. 95: 304309.
25. Faghiri, Z.,, W. A. Wilson,, F. Taheri,, E. N. Barton,, O. S. Morgan, and , A. E. Gharavi. 1999. Antibodies to cardio-lipin and beta2-glycoprotein-1 in HTLV-1-associated myelopathy/tropical spastic paraparesis. Lupus 8: 210214.
26. Favaloro, E. J., and , R. Silvestrini. 2002. Assessing the usefulness of anticardiolipin antibody assays: a cautious approach is suggested by high variation and limited consensus in multi-laboratory testing. Am. J. Clin. Pathol. 118: 548557.
27. Favaloro, E. J.,, R. C. Wong,, R. Silvestrini,, R. McEvoy,, S. Jovanovich, and , P. Roberts-Thomson. 2005. A multila-boratory peer assessment quality assurance program-based evaluation of anticardiolipin antibody, and beta2-glycoprotein I antibody testing. Semin. Thromb. Hemost. 31: 7384.
28. Galli, M.,, P. Comfurius,, C. Maassen,, H. C. Hemker,, M. H. De Baets,, P. J. Van Breda-Vriesman,, T. Barbui,, R. E. Zwaal, and , E. M. Bevers. 1990. Anticardiolipin antibodies (ACA) directed not to cardiolipin but to a plasma cofactor. Lancet 335: 15441547.
29. Galli, M.,, D. Luciani,, G. Bertolini, and , T. Barbui. 2003. Lupus anticoagulants are stronger risk factors for thrombosis than anticardiolipin antibodies in the antiphospholipid syndrome: a systematic review of the literature. Blood 101: 18271832.
30. Gharavi, A.,, E. N. Harris,, R. Asherson, and , G. Hughes. 1987. Anticardiolipin antibodies: isotype distribution and phospholipid specificity. Ann. Rheum. Dis. 46: 16.
31. Gharavi, A. E., and , M. D. Lockshin. 2002. Antiphospholipid antibody tests, p. 973980. In N. R. Rose,, R. G. Hamilton, and , B. Detrick (ed.), Manual of Clinical Laboratory Immunology, 6th ed. ASM Press, Washington, D.C.
32. Greaves, M. 2000. Antiphospholipid syndrome: state of the art with emphasis on laboratory evaluation. Haemostasis 30(Suppl. 2): 1625.
33. Greaves, M.,, H. Cohen,, S. J. MacHin, and , I. Mackie. 2000. Guidelines on the investigation and management of the antiphospholipid syndrome. Br. J. Haematol. 109: 704715.
34. Guedes Barbosa, L. S.,, B. Gilbrut,, Y. Shoenfeld, and , M. A. Scheinberg. 1996. Autoantibodies in leprosy sera. Clin. Rheumatol. 15: 2628.
35. Harris, E. N. 1990. Special report. The second international anti-cardiolipin standardization workshop/the Kingston anti-phospholipid antibody study (KAPS) group. Am. J. Clin. Pathol. 94: 476484.
36. Harris, E. N.,, J. K. Chan,, R. Asherson,, V. R. Aber,, A. Gharavi, and , G. Hughes. 1986. Thrombosis, recurrent fetal loss, and thrombocytopenia: predictive value of the anticardiolipin antibody test. Arch. Intern. Med. 146: 21532156.
37. Harris, E. N.,, A. Gharavi,, M. L. Boey,, B. M. Patel,, C. Mackworth-Young,, S. Loizou, and , G. Hughes. 1983. Anticardiolipin antibodies: detection by radioimmunoassay and association with thrombosis in systemic lupus erythematosus. Lancet ii: 12111214.
38. Harris, E. N.,, A. Gharavi,, S. P. Patel, and , G. Hughes. 1987. Evaluation of the anti-cardiolipin antibody test: report of an international workshop held 4 April 1986. Clin. Exp. Immunol. 68: 215222.
39. Harris, E. N.,, S. Pierangeli, and , D. Birch. 1994. Anticardiolipin wet workshop report. Fifth International Symposium on antiphospholipid antibodies. Am. J. Clin. Pathol. 101: 616624.
40. Katano, K.,, A. Aoki,, H. Sasa,, M. Ogasawara,, E. Matsuura, and , Y. Yagami. 1996. Beta 2-glycoprotein I-dependent anticardiolipin antibodies as a predictor of adverse pregnancy outcomes in healthy pregnant women. Hum. Reprod. 11: 509512.
41. Leroy, V.,, J. Arvieux,, M. C. Jacob,, M. Maynard-Muet,, M. Baud, and , J. P. Zarski. 1998. Prevalence and significance of anticardiolipin, anti-beta2 glycoprotein I and anti-prothrombin antibodies in chronic hepatitis C. Br. J. Haematol. 101: 468474.
42. Levine, J. S.,, D. W. Branch, and , J. Rauch. 2002. The antiphospholipid syndrome. N. Engl. J. Med. 346: 752763.
43. Loizou, S.,, S. Singh,, E. Wypkema, and , R. A. Asherson. 2003. Anticardiolipin, anti-beta(2)-glycoprotein I and antiprothrombin antibodies in black South African patients with infectious disease. Ann. Rheum. Dis. 62: 11061111.
44. Love, P. E., and , S. A. Santoro. 1990. Antiphospholipid antibodies: anticardiolipin and the lupus anticoagulant in systemic lupus erythematosus (SLE) and in non-SLE disorders. Prevalence and clinical significance. Ann. Intern. Med. 112: 682698.
45. Maclean, C.,, P. J. Flegg, and , D. C. Kilpatrick. 1990. Anticardiolipin antibodies and HIV infection. Clin. Exp. Immunol. 81: 263266.
46. Martinuzzo, M. E.,, R. R. Forastiero, and , L. O. Carreras. 1995. Anti beta 2 glycoprotein I antibodies: detection and association with thrombosis. Br. J. Haematol. 89: 397402.
47. McCrae, K. R. 1996. Antiphospholipid antibody associated thrombosis: a consensus for treatment? Lupus 5: 560570.
48. McNeil, H. P., and , S. A. Krilis. 1991. Antiphospholipid antibodies. Aust. N. Z. J. Med. 21: 463475.
49. McNeil, H. P.,, R. J. Simpson,, C. N. Chesterman, and , S. Krilis. 1990. Anti-phospholipid antibodies are directed against a complex antigen that includes a lipid-binding inhibitor of coagulation: beta2-glycoprotein I (apolipopro-tein H). Proc. Natl. Acad. Sci. USA 87: 41204124.
50. Merkel, P. A.,, Y. Chang,, S. S. Pierangeli,, E. N. Harris, and , R. P. Polisson. 1999. Comparison between the standard anticardiolipin antibody test and a new phospholipid test in patients with connective tissue diseases. J. Rheumatol. 26: 591596.
51. Molina, J. F.,, S. Gutierrez-Urena,, J. Molina,, O. Uribe,, S. Richards,, C. De Ceulaer,, C. Garcia,, W. A. Wilson,, A. E. Gharavi, and , L. R. Espinoza. 1997. Variability of anticardiolipin antibody isotype distribution in 3 geographic populations of patients with systemic lupus erythematosus. J. Rheumatol. 24: 291296.
52. Musial, J.,, J. Swadzba,, A. Motyl, and , T. Iwaniec. 2003. Clinical significance of antiphospholipid protein antibodies. Receiver operating characteristics plot analysis. J. Rheumatol. 30: 723730.
53. Nash, M. J.,, R. S. Camilleri,, S. Kunka,, I. J. Mackie,, S. J. Machin, and , H. Cohen. 2004. The anticardiolipin assay is required for sensitive screening for antiphospholipid antibodies. J. Thromb. Haemost. 2: 10771081.
54. Neville, C.,, J. Rauch,, J. Kassis,, E. R. Chang,, L. Joseph,, M. Le Comte, and , P. R. Fortin. 2003. Thromboembolic risk in patients with high titre anticardiolipin and multiple antiphospholipid antibodies. Thromb. Haemost. 90: 108115.
55. Ogasawara, M.,, K. Aoki,, E. Matsuura,, H. Sasa, and , Y. Yagami. 1996. Anti beta 2glycoprotein I antibodies and lupus anticoagulant in patients with recurrent pregnancy loss: prevalence and clinical significance. Lupus 5: 587592.
56. Oosting, J. D.,, R. H. Derksen,, I. W. Bobbink,, T. M. Hackeng,, B. N. Bouma, and , P. G. de Groot. 1993. Antiphospholipid antibodies directed against a combination of phospholipids with prothrombin, protein C, or protein S: an explanation for their pathogenic mechanism? Blood 81: 26182625.
57. Pangborn, M. C. 1941. A new serologically active phospholipid from beef heart. Proc. Soc. Exp. Biol. Med. 48: 484486.
58. Pierangeli, S. S.,, A. E. Gharavi, and , E. N. Harris. 2001. Testing for antiphospholipid antibodies: problems and solutions. Clin. Obstet. Gynecol. 44: 4857; quiz, 5859.
59. Pierangeli, S. S., and , E. N. Harris. 2005. Clinical laboratory testing for the antiphospholipid syndrome. Clin. Chim. Acta 357: 1733.
60. Pierangeli, S. S.,, M. Stewart,, L. K. Silva, and , E. N. Harris. 1998. An antiphospholipid wet workshop: 7th International Symposium on Antiphospholipid Antibodies. J. Rheumatol. 25: 156160.
61. Reber, G.,, J. Arvieux,, E. Comby,, D. Degenne,, P. de Moerloose,, M. Sanmarco, and , G. Potron. 1995. Multicenter evaluation of nine commercial kits for the quantitation of anticardiolipin antibodies. The Working Group on Methodologies in Haemostasis from the GEHT (Groupe d’Etudes sur l’Hemostase et la Thrombose). Thromb. Haemost. 73: 444452.
62. Reber, G., and , P. de Moerloose. 2004. Anti-beta2-glycoprotein I antibodies—when and how should they be measured? Thromb. Res. 114: 527531.
63. Reber, G.,, I. Schousboe,, A. Tincani,, M. Sanmarco,, T. Kveder,, P. de Moerloose,, M. C. Boffa, and , J. Arvieux. 2002. Inter-laboratory variability of anti-beta2-glycoprotein I measurement. A collaborative study in the frame of the European Forum on Antiphospholipid Antibodies Standardization Group. Thromb. Haemost. 88: 6673.
64. Roubey, R. A. 1994. Autoantibodies to phospholipid-binding plasma proteins: a new view of lupus anticoagulants and other “antiphospholipid” autoantibodies. Blood 84: 28542867.
65. Roubey, R. A.,, R. A. Eisenberg,, M. F. Harper, and , J. B. Winfield. 1995. “Anticardiolipin” autoantibodies recognize beta 2-glycoprotein I in the absence of phospholipid. Importance of Ag density and bivalent binding. J. Immunol. 154: 954960.
66. Samarkos, M.,, R. A. Asherson, and , S. Loizou. 2001. The clinical significance of IgA antiphospholipid antibodies. J. Rheumatol. 28: 694697.
67. Sebastiani, G. D.,, M. Galeazzi,, A. Tincani,, J. C. Piette,, J. Font,, F. Allegri,, A. Mathieu,, J. Smolen,, E. de Ramon Garrido,, A. Fernandez-Nebro,, A. Jedryka-Goral,, C. Papasteriades,, G. Morozzi,, E. Bellisai,, O. De Pita, and , R. Marcolongo. 1999. Anticardiolipin and anti-beta2GPI antibodies in a large series of European patients with systemic lupus erythematosus. Prevalence and clinical associations. European Concerted Action on the Immunogenetics of SLE. Scand. J. Rheumatol. 28: 344351.
68. Simmelink, M. J.,, D. A. Horbach,, R. H. Derksen,, J. C. Meijers,, E. M. Bevers,, G. M. Willems, and , P. G. De Groot. 2001. Complexes of anti-prothrombin antibodies and prothrombin cause lupus anticoagulant activity by competing with the binding of clotting factors for catalytic phospholipid surfaces. Br. J. Haematol. 113: 621629.
69. Soni, P. N.,, C. C. De Bruyn,, J. Duursma,, B. L. Sharp, and , D. J. Pudifin. 1993. Are anticardiolipin antibodies responsible for some of the complications of severe acute Plasmodium falciparum malaria? S. Afr. Med. J. 83: 660662.
70. Tincani, A.,, F. Allegri,, G. Balestrieri,, G. Reber,, M. Sanmarco,, P. Meroni, and , M. C. Boffa. 2004. Minimal requirements for antiphospholipid antibodies ELISAs proposed by the European Forum on antiphospholipid antibodies. Thromb. Res. 114: 553558.
71. Triplett, D. A. 2002. Antiphospholipid antibodies. Arch. Pathol. Lab. Med. 126: 14241429.
72. Triplett, D. A. 1998. Many faces of lupus anticoagulants. Lupus 7(Suppl. 2): S18S22.
73. Viard, J. P.,, Z. Amoura, and , J. E. Bach. 1992. Association of anti-beta 2 glycoprotein I antibodies with lupus-type circulating anticoagulant and thrombosis in systemic lupus erythematosus. Am J. Med. 93: 181186.
74. Vila, P.,, M. C. Hernandez,, M. F. Lopez-Fernandez, and , J. Batlle. 1994. Prevalence, follow-up and clinical significance of the anticardiolipin antibodies in normal subjects. Thromb. Haemost. 72: 209213.
75. Wahl, D. G.,, E. De Maistre,, E. Guillemin,, V. Regnault,, C. Perret-Guillaume, and , T. Lecompte. 1998. Antibodies against phospholipids and beta 2-glycoprotein I increase the risk of recurrent venous thromboembolism in patients without systemic lupus erythematosus. Q. J. Med. 91: 125130.
76. Wassermann, A.,, A. Neisser, and , C. Bruck. 1906. Eine serodiagnostiche Reaction bei Syphilis. Dtsch. Med. Wochenschr. 32: 745746.
77. Wilson, W.,, A. Gharavi,, T. Koike,, M. Lockshin,, D. W. Branch,, J. C. Piette,, R. Brey,, R. Derksen,, E. N. Harris,, G. Hughes,, D. A. Triplett, and , M. Khamashta. 1999. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome. Arthritis Rheum. 42: 13091311.
78. Wilson, W A.,, C. Morgan Ost,, E. N. Barton,, M. Smikle,, B. Hanchard,, W A. Blattner,, S. Doggett, and , A. E. Gharavi. 1995. IgA antiphospholipid antibodies in HTLV-1-associated tropical spastic paraparesis. Lupus 4: 138141.
79. Wong, R.,, E. Favaloro,, W. Pollock,, R. Wilson,, M. Hendle,, S. Adelstein,, K. Baumgart,, P. Homes,, S. Smith,, R. Steele,, A. Sturgess, and , D. Gillis. 2004. A multi-centre evaluation of the intra-assay and inter-assay variation of commercial and in-house anti-cardiolipin antibody assays. Pathology 36: 182192.
80. Wong, R. C.,, D. Gillis,, S. Adelstein,, K. Baumgart,, E. J. Favaloro,, M. J. Hendle,, P. Homes,, W Pollock,, S. Smith,, R. H. Steele,, A. Sturgess, and , R. J. Wilson. 2004. Consensus guidelines on anti-cardiolipin antibody testing and reporting. Pathology 36: 6368.


Generic image for table

Summary of the criteria for classification of APS

Citation: Schmitz J. 2006. Laboratory Testing for Antibodies Associated with Antiphospholipid Antibody Syndrome, p 1046-1052. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch117

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error