Antiphospholipid Antibody Testing: An Audit on Testing Practices in a Public Tertiary Care Center

Author:

Mansory Eman M.12ORCID,Alahwal Hatem M.12ORCID,Bahashwan Salem M.12ORCID,Radhwi Osman12ORCID,Almohammadi Abdullah T.12ORCID,Daghistani Yassir3,Al-Mughales Jamil45ORCID,Barefah Ahmed S.12ORCID

Affiliation:

1. Hematology Department, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia

2. Hematology Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia

3. Department of Medicine, College of Medicine, University of Jeddah, Jeddah 23890, Saudi Arabia

4. Department of Clinical Laboratories, Diagnostic Immunology Division, King Abdulaziz University, Jeddah 21589, Saudi Arabia

5. Department of Clinical Microbiology and Immunology, King Abdulaziz University, Jeddah 21589, Saudi Arabia

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.

Publisher

MDPI AG

Subject

General Medicine

Reference36 articles.

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