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Mansory EM, Alahwal HM, Bahashwan SM, Radhwi O, Almohammadi AT, Daghistani Y, Al-Mughales J, Barefah AS. Antiphospholipid Antibody Testing: An Audit on Testing Practices in a Public Tertiary Care Center. J Clin Med 2023; 13:243. [PMID: 38202249 PMCID: PMC10780093 DOI: 10.3390/jcm13010243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND 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. OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Eman M. Mansory
- Hematology Department, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (H.M.A.); (S.M.B.); (O.R.); (A.T.A.); (A.S.B.)
- Hematology Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Hatem M. Alahwal
- Hematology Department, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (H.M.A.); (S.M.B.); (O.R.); (A.T.A.); (A.S.B.)
- Hematology Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Salem M. Bahashwan
- Hematology Department, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (H.M.A.); (S.M.B.); (O.R.); (A.T.A.); (A.S.B.)
- Hematology Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Osman Radhwi
- Hematology Department, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (H.M.A.); (S.M.B.); (O.R.); (A.T.A.); (A.S.B.)
- Hematology Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Abdullah T. Almohammadi
- Hematology Department, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (H.M.A.); (S.M.B.); (O.R.); (A.T.A.); (A.S.B.)
- Hematology Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Yassir Daghistani
- Department of Medicine, College of Medicine, University of Jeddah, Jeddah 23890, Saudi Arabia;
| | - Jamil Al-Mughales
- Department of Clinical Laboratories, Diagnostic Immunology Division, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Department of Clinical Microbiology and Immunology, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ahmed S. Barefah
- Hematology Department, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (H.M.A.); (S.M.B.); (O.R.); (A.T.A.); (A.S.B.)
- Hematology Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Caraiola S, Voicu L, Baicus A, Baicus C. Criteria and Non-Criteria Antiphospholipid Antibodies and Cancer in Patients with Involuntary Weight Loss. J Pers Med 2023; 13:1549. [PMID: 38003864 PMCID: PMC10671946 DOI: 10.3390/jpm13111549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
Cancer patients have higher prevalences of antiphospholipid antibodies (aPLs), occasionally associated with thrombotic events. A cross-sectional study regarding the presence of criteria (IgG/IgM anti-cardiolipin-aCL, anti-β2 glycoprotein I-aβ2GPI) and non-criteria (IgG/IgM anti-phosphatidylserine-aPS, anti-phosphatidylethanolamine-aPE, anti-prothrombin-aPT) aPLs in 146 patients with involuntary weight loss was performed. None of the patients had thrombotic events during the study. Out of the 36 cancer patients, 33 had non-hematologic malignancies. In the cancer subgroup, 60% of the patients had at least one positive aPL, with significantly more patients being positive for aβ2GPI IgG compared with the non-cancer subgroup-p = 0.03, OR = 2.23 (1.02-4.88). When evaluating the titres, aCL IgG/IgM, aβ2GPI IgG, aPE IgG, and aPS IgG had significantly higher values in cancer patients, the best cancer predictor being aβ2GPI IgG-AUC 0.642 (0.542-0.742). Gastrointestinal cancer patients were studied separately, and aCL IgM positivity was significantly higher-p = 0.008, OR = 6.69 (1.35-33.02). Both the titres of aCL IgM (p = 0.006) and aPS IgM (p = 0.03) were higher in the gastrointestinal cancer subgroup, with aCL IgM being the best predictor for gastrointestinal cancer development-AUC 0.808 (0.685-0.932). Despite criteria and non-criteria aPLs being frequent in cancer, their connection with thrombosis in these patients is probably dependent on other important risk factors and needs further research.
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Affiliation(s)
- Simona Caraiola
- Fifth Department-Internal Medicine (Cardiology, Gastroenterology, Hepatology, Rheumatology, Geriatrics), Family Medicine, Occupational Medicine, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Internal Medicine Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Laura Voicu
- Internal Medicine Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Anda Baicus
- Fifth Department-Internal Medicine (Cardiology, Gastroenterology, Hepatology, Rheumatology, Geriatrics), Family Medicine, Occupational Medicine, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Laboratory Department, The University Emergency Hospital, 050098 Bucharest, Romania
| | - Cristian Baicus
- Fifth Department-Internal Medicine (Cardiology, Gastroenterology, Hepatology, Rheumatology, Geriatrics), Family Medicine, Occupational Medicine, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Internal Medicine Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
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