Triplett D A
Midwest Hemostasis and Thrombosis Laboratories, Muncie, IN 47303, USA.
Clin Lab Sci. 1997 Jul-Aug;10(4):223-8.
Lupus anticoagulants (LAs) are immunoglobulins which prolong 1 or more of the in vitro phospholipid-dependent tests of coagulation (e.g., activated partial thromboplastin time [APTT], dilute Russell viper venom time [dRVVT], kaolin clotting time [KCT], and textarin time [TT]). Paradoxically, patients with LAs rarely experience hemorrhagic problems. Approximately 1/3 of individuals with LAs experience thromboembolic complications such as stroke, deep vein thrombosis, and pulmonary emboli. LAs are members of the antiphospholipid antibody (APA) family. The APA family includes: LAs, anticardiolipin antibodies (ACAs), and reagin (the antibody responsible for the positive serologic test for syphilis). In approximately 60% of the patients, a LA and an ACA will both be present. The diagnosis of LAs requires an organized approach. Careful preparation of platelet poor plasma (PPP) is essential to assure maximum detection of LA. In order to rule out LAs, it is necessary to perform at least 2 screening tests (e.g., APTT, dRVVT). Additional steps in the diagnosis of LAs include mixing studies to identify the presence of an inhibitor and confirmatory procedures to demonstrate phospholipid-dependence of the inhibitor. It is also important to rule out any other potential coagulopathies which may account for the prolonged screening studies.
狼疮抗凝物（LA）是一类免疫球蛋白，可延长一项或多项体外磷脂依赖性凝血试验（如活化部分凝血活酶时间[APTT]、稀释蝰蛇毒时间[dRVVT]、高岭土凝血时间[KCT]和苔红素时间[TT]）。矛盾的是，患有LA的患者很少出现出血问题。大约三分之一患有LA的个体经历血栓栓塞并发症，如中风、深静脉血栓形成和肺栓塞。LA是抗磷脂抗体（APA）家族的成员。APA家族包括：LA、抗心磷脂抗体（ACA）和反应素（梅毒血清学检测阳性所对应的抗体）。在大约60%的患者中，LA和ACA会同时存在。LA的诊断需要有条理的方法。仔细制备乏血小板血浆（PPP）对于确保最大程度检测LA至关重要。为了排除LA，有必要至少进行两项筛查试验（如APTT、dRVVT）。LA诊断的其他步骤包括混合试验以确定抑制剂的存在，以及确证程序以证明抑制剂的磷脂依赖性。排除任何可能导致筛查试验延长的其他潜在凝血病也很重要。
