Antiphospholipid antibodies in a healthy population: methods for estimating the distribution.

OBJECTIVE

To determine the distribution of antibodies to cardiolipin (IgG, IgM and IgA) in a healthy population. To classify subjects according to a cutpoint in order to determine what level of antibody measurement would yield 95% specificity.

METHODS

Antiphospholipid (aPL) antibodies were measured using a conventional ELISA technique, with isotype specific antibody, to determine levels of IgG, IgM and IgA binding to cardiolipin. The subjects were 282 Red Cross blood donors, 82 undergraduate medical and nursing students, and 13 laboratory volunteers.

RESULTS

The distribution of aPL antibodies measured in units of optical density is significantly skewed, while the distribution of aPL antibodies measured on the log scale is nearly symmetric. Neither distribution is normally distributed. There was no evidence that aPL antibodies differed significantly by age (up to age 50) or sex. We estimate the 90th, 95th, and 99th percentiles for IgG, IgM and IgA antibodies for the optical densities and binding indices.

CONCLUSION

For 95% specificity we conclude that an adjusted IgG optical density above 0.386, an adjusted IgM optical density above 0.301, or an adjusted IgA optical density above 0.085 be considered positive.