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Test Code ALUPP Lupus Anticoagulant Profile, Plasma


Ordering Guidance


Multiple coagulation profile tests are available. See Coagulation Profile Comparison for testing that is performed with each profile.



Shipping Instructions


Send the aliquots in the same shipping container.



Necessary Information


Note if patient is currently receiving anticoagulant (eg, heparin, Coumadin [warfarin]) treatment.



Specimen Required


Patient Preparation:

1. Patient should not be receiving anticoagulant treatment (eg, warfarin, heparin). Treatment with heparin causes false-positive results of in vitro coagulation testing for lupus anticoagulant. Coumadin (warfarin) treatment may impair ability to detect the more subtle varieties of lupus-like anticoagulants.

2. Patient should also not be receiving fibrinolytic agents (streptokinase, urokinase, tissue plasminogen activator: tPA).

3. If patient has been recently transfused, it is best to perform this study pretransfusion, if possible.

 

Specimen Type: Platelet-poor plasma

Collection Container/Tube: Light-blue top (citrate)

Submission Container/Tube: Plastic vials

Specimen Volume: 4 mL in 4 plastic vials each containing 1 mL

Collection Instructions:

1. Specimen must be collected prior to factor replacement therapy.

2. For complete instructions, see Coagulation Guidelines for Specimen Handling and Processing.

3. Centrifuge, transfer all plasma into a plastic vial, and centrifuge plasma again.

4. Aliquot plasma (1-2 mL per aliquot) into 4 separate plastic vials, leaving 0.25 mL in the bottom of centrifuged vial.

5. Freeze plasma immediately (no longer than 4 hours after collection) at -20° C or, ideally, -40° C or below.

Additional Information:

1. Double-centrifuged specimen is critical for accurate results as platelet contamination may cause spurious results.

2. Each coagulation assay requested should have its own vial.


Forms

1. Coagulation Patient Information (T675)

2. If not ordering electronically, complete, print, and send a Coagulation Test Request (T753) with the specimen.

Secondary ID

603463

Useful For

Confirming or excluding the presence of lupus anticoagulant (LA), distinguishing LA from specific coagulation factor inhibitors and nonspecific inhibitors

 

Investigating a prolonged activated thromboplastin time, especially when combined with other coagulation studies

 

This test is not useful for the detection of antiphospholipid antibodies that do not affect coagulation tests. We recommend separate testing for serum phospholipid (cardiolipin), IgG and IgM (CLPMG) and beta-2 glycoprotein 1, IgG and IgM (B2GMG).

Profile Information

Test ID Reporting Name Available Separately Always Performed
ALUPI Lupus Anticoagulant Tech Interp No Yes
PTSC Prothrombin Time (PT), P Yes, (order PTTP) Yes
APTSC Activated Partial Thrombopl Time, P Yes, (order APTTP) Yes
DRV1 Dilute Russells Viper Venom Time, P Yes, (order DRVI1) Yes

Testing Algorithm

Initial testing includes prothrombin time (PT), activated partial thromboplastin time (aPTT), and dilute Russell's viper venom time (dRVVT).

 

If the PT, aPTT, and dRVVT are normal, a computer-generated interpretive comment indicating no evidence of a lupus anticoagulant (LA) will be provided.

 

If PT is greater than 13.9 seconds, PT mix will be performed at an additional charge.

 

If aPTT is greater than or equal to 38 seconds, aPTT mix will be performed at an additional charge.

 

If PT, aPTT, or dRVVT are prolonged, thrombin time (TT) will be performed at an additional charge.

 

If aPTT mix is greater than or equal to 38 seconds and thrombin time is less than 35.0 seconds (no evidence of heparin), platelet neutralization procedure will be performed at an additional charge.

 

If dRVVT ratio is greater than or equal to 1.20, dRVVT mix and dRVVT confirmation will be performed at an additional charge.

 

If TT is greater than or equal to 25.0 seconds, reptilase will be performed at an additional charge.

 

If appropriate, coagulation factor assays, fibrinogen, D-dimer, hexagonal LA, and soluble fibrin monomer will be performed, at an additional charge, to clarify a significant abnormality in the screen test results.

 

If the factor VIII, IX or V result is below the normal range, the factor inhibitor screen may be performed along with the Bethesda titering assay, if indicated, at an additional charge.

 

If any test results are abnormal, all results will be reviewed by a coagulation consultant and a lupus anticoagulant interpretation will be provided.

 

For more information see Lupus Anticoagulant Profile Testing Algorithm.

Method Name

PTSC, APTSC, DRV1: Optical Clot-Based

Reporting Name

Lupus Anticoagulant Prof

Specimen Type

Plasma Na Cit

Specimen Minimum Volume

3 mL in 3 plastic vials each containing 1 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Plasma Na Cit Frozen 14 days

Reject Due To

Gross hemolysis Reject
Gross lipemia Reject
Gross icterus Reject

Clinical Information

Lupus anticoagulant (LA) is an antibody to negatively charged phospholipid that interferes with phospholipid-dependent coagulation tests.

 

LA is found in, but not limited to, patients with systemic lupus erythematosus; LA is associated with other autoimmune disorders and collagen vascular disease and occurs in response to medications or certain infections (eg, respiratory tract infections in children) and in individuals with no obvious underlying disease.

 

LA has been associated with arterial and venous thrombosis and fetal loss. Individuals with thrombocytopenia or factor II deficiency associated with LA may be at risk for bleeding.

Reference Values

An interpretive report will be provided.

Interpretation

An interpretive report will be provided when testing is complete.

Cautions

No significant cautionary statements

Clinical Reference

1. Arnout J, Vermylen J: Current status and implications of autoimmune antiphospholipid antibodies in relation to thrombotic disease. J Thromb Haemost. 2003 May;1(5):931-942

2. Levin JS, Branch DW, Rauch J: The antiphospholipid syndrome. New Engl J Med. 2002 Mar 7;346(10):752-763

3. Proven A, Bartlett RP, Moder KG et al: Clinical importance of positive tests for lupus anticoagulant and anticardiolipin antibodies. Mayo Clin Proc. 2004 Apr,79(4):467-475

4. Kitches CS, Kessler CM, Konkle BA, et al, eds: Consultative Hemostasis and Thrombosis. 4th ed. Elsevier; 2019:374-395

Method Description

Prothrombin Time:

The prothrombin time (PT) assay is performed on the Instrumentation Laboratory ACL TOP. Patient plasma is incubated and combined with a PT reagent containing recombinant human tissue factor, synthetic phospholipids, calcium chloride, polybrene, and buffer. The tissue thromboplastin-factor VII/VIIa complex activates factor X. Activated factor X (factor Xa) forms a complex with factor Va, calcium, and phospholipid to activate factor II (prothrombin) to thrombin. Thrombin then acts on fibrinogen (factor I) to form fibrin which clots, the time to clot formation is measured optically using a wavelength of 671 nm providing the assay endpoint (the "prothrombin time").(Package insert: HemosIL RecombiPlasTin 2G. Instrumentation Laboratory Company; R0, 03/2019)

 

Activated Partial Thromboplastin Time:

The activated partial thromboplastin time (aPTT) assay is performed on the Instrumentation Laboratory ACL TOP. Patient plasma is combined and incubated with an aPTT reagent containing phospholipid, a negatively charged contact factor activator, and buffer. After a specified incubation time, calcium is added to trigger the coagulation process in the mixture. Subsequently, the time to clot formation is measured optically using a wavelength of 671 nm. Mixing studies (see APMSC / Activated Partial Thromboplastin Time (APTT) Mix 1:1, Plasma) using normal pooled plasma are performed in the Special Coagulation Laboratory on samples with a prolonged aPTT, to assist in discriminating between factor deficiency states and coagulation inhibitors, unless further testing is not indicated.(Package insert: HemosIL SynthASil. Instrumentation Laboratory Company; R11, 06/2017)

 

Dilute Russell's Viper Venom Time:

The dilute Russell's viper venom time (dRVVT) screening assay is performed on the Instrumentation Laboratory ACL TOP. Patient plasma is incubated for a specified time, and then combined with a dRVVT screening reagent containing Russell's viper venom, phospholipids, heparin neutralizing agents, calcium, buffers and stabilizers to trigger the coagulation process. Subsequently, the time to clot formation is measured optically using a wavelength of 671 nm. The patient dRVVT screening clotting time is normalized by dividing the patient result by the mean DRVVT screening clotting time of normal pooled plasma to yield a ratio (dRVVT screen ratio).(Package insert: LA CHECK DRVVT. Precision Biologic; R14, 03/2012)

Day(s) Performed

Monday through Friday

Report Available

3 to 5 days

Specimen Retention Time

7 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Test Classification

See Individual Test IDs

CPT Code Information

85610

85730

85613

85390

85130 (if appropriate)

85130 (if appropriate)

85210 (if appropriate)

85220 (if appropriate)

85230 (if appropriate)

85240 (if appropriate)

85245 (if appropriate)

85246 (if appropriate)

85247 (if appropriate)

85250 (if appropriate)

85260 (if appropriate)

85270 (if appropriate)

85280 (if appropriate)

85335 (if appropriate)

85335 (if appropriate)

85335 (if appropriate)

85366 (if appropriate)

85379 (if appropriate)

85384 (if appropriate)

85385 (if appropriate)

85390-26 (if appropriate)

85397 (if appropriate)

85597 (if appropriate)

85598 (if appropriate)

85611 (if appropriate)

85613 (if appropriate)

85613 (if appropriate)

85635 (if appropriate)

85670 (if appropriate)

85732 (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
ALUPP Lupus Anticoagulant Prof 75881-3

 

Result ID Test Result Name Result LOINC Value
RVR1 DRVVT Screen Ratio 15359-3
PTSEC Prothrombin Time (PT), P 5902-2
APTSC Activated Partial Thrombopl Time, P 14979-9
ALUPI Lupus Anticoagulant Tech Interp 75882-1
INRSC INR 6301-6

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
DIMER D-Dimer, P Yes, (order DDITT) No
F8IS Coag Factor VIII Assay Inhib Scrn,P No No
FACTV Coag Factor V Assay, P Yes No
F_7 Coag Factor VII Assay, P Yes No
TTSC Thrombin Time (Bovine), P Yes No
F_9 Coag Factor IX Assay, P Yes No
F_10 Coag Factor X Assay, P Yes No
F_11 Coag Factor XI Assay, P Yes No
F_12 Coag Factor XII Assay, P Yes No
F8A Coag Factor VIII Activity Assay, P Yes No
RTSC Reptilase Time, P Yes No
F_2 Coag Factor II Assay, P Yes No
CLFIB Fibrinogen, Clauss, P Yes, (order FIBTP) No
SOLFM Soluble Fibrin Monomer No No
PNP Platelet Neutralization Procedure No No
PTMSC PT Mix 1:1 No No
APMSC APTT Mix 1:1 No No
DRV2 DRVVT Mix No No
DRV3 DRVVT Confirmation No No
ALUPO Lupus Anticoagulant Interp No No
RIST Ristocetin Cofactor, P No No
F5_IS Factor V Inhib Scrn No No
VWFMP von Willebrand Factor Multimer, P Yes, ( order VWFMS ) No
PTFIB PT-Fibrinogen, P Yes No
VWAG von Willebrand Factor Ag, P Yes No
VWACT von Willebrand Factor Activity, P Yes No
CH9 Chromogenic FIX, P Yes No
5BETH FV Bethesda Units, P No No
F9_IS Factor IX Inhib Scrn No No
8BETH FVIII Bethesda Units, P No No
9BETH FIX Bethesda Units, P No No
CHF8 Chromogenic FVIII, P Yes No
HEXLA HEX LA, P No No