Mansory Eman M, Alahwal Hatem M, Bahashwan Salem M, Radhwi Osman, Almohammadi Abdullah T, Daghistani Yassir, Al-Mughales Jamil, Barefah Ahmed S
Hematology Department, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
Hematology Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
J Clin Med. 2023 Dec 31;13(1):243. doi: 10.3390/jcm13010243.
Antiphospholipid antibodies (aPLs) are antibodies directed against cell membrane components and can be associated with clinical features or be asymptomatic. Testing and interpreting these antibodies is associated with many challenges and pitfalls in clinical practice.
To review all antiphospholipid antibody testing and describe the testing practices, indications for testing and interpretation of results to infer local challenges with aPL testing and subsequently address ways to overcome those challenges.
This is a retrospective analysis of all aPL testing done in a tertiary center between 2014 and 2018. Characteristics of study patients collected through chart review were described using the mean and standard deviation for continuous variables and proportion for categorical variables. Group differences were compared between patients with any aPL-positive result and those with no positive result using chi-square or Fisher's exact test as appropriate for categorical variables and a simple regression model for numerical variables.
Among 414 patients undergoing aPL testing, mainly adult females, 62 (14.9%) patients had at least one positive antibody, of those, 26 (42%) had repeat testing done. Testing was mostly done for obstetric indication (107, 25.8%), with 36 patients having one or two early pregnancy losses <10 weeks as their testing indication. A total of 27 (6.5%) patients were labeled with APS/possible APS based on chart review, but on review of the testing of those patients according to classification criteria, only nine patients satisfied the criteria for APS.
This study highlights the clinical challenges associated with aPL testing, including the controversies around indication for testing, the low rates of repeat testing to confirm persistence, and the common misinterpretation of results. Having an aPL testing profile, explicit reference ranges, results commentary, and close interaction between ordering physicians and laboratory staff might be starting points to overcome these challenges.
抗磷脂抗体（aPLs）是针对细胞膜成分的抗体，可伴有临床特征或无症状。在临床实践中，检测和解释这些抗体存在许多挑战和陷阱。
回顾所有抗磷脂抗体检测，描述检测方法、检测指征及结果解读，以推断aPL检测在当地面临的挑战，并随后探讨克服这些挑战的方法。
这是一项对2014年至2018年在一家三级中心进行的所有aPL检测的回顾性分析。通过病历审查收集的研究患者特征，对于连续变量用均值和标准差描述，对于分类变量用比例描述。对于分类变量，使用卡方检验或Fisher精确检验比较任何aPL检测结果为阳性的患者与无阳性结果的患者之间的组间差异；对于数值变量，使用简单回归模型进行比较。
在414例接受aPL检测的患者中，主要为成年女性，62例（14.9%）患者至少有一种抗体呈阳性，其中26例（42%）进行了重复检测。检测主要是出于产科指征（107例，25.8%），36例患者以一次或两次妊娠10周前早期流产作为检测指征。根据病历审查，共有27例（6.5%）患者被标记为抗磷脂综合征/可能的抗磷脂综合征，但根据分类标准对这些患者的检测结果进行复查时，只有9例患者符合抗磷脂综合征标准。
本研究突出了与aPL检测相关的临床挑战，包括检测指征的争议、确认持续性的重复检测率低以及结果的常见误判。拥有aPL检测概况、明确的参考范围、结果注释以及开单医生与实验室工作人员之间的密切互动可能是克服这些挑战的起点。
