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To help investigate the presence of blood clots or an unexpectedly prolonged PTT (partial thromboplastin time), especially if you have had recurrent miscarriages; as part of an evaluation for antiphospholipid syndrome (APS); sometimes to help diagnose or evaluate an autoimmune disorder
When you have an unexplained prolonged PTT test; when you have had recurrent unexplained blood clots; when you have had recurrent miscarriages, especially in the second and third trimesters
A blood sample drawn from a vein in your arm
Antiphospholipid antibodies are a group of immune proteins (antibodies) that the body mistakenly produces against itself in an autoimmune response to phospholipids. Tests can detect these autoantibodies that bind to phospholipids and, in a way that is not well understood, increase the risk of excessive blood clotting.
Several tests are available, including:
Phospholipids are structural components of cell membranes and play a crucial role in blood clotting. Phospholipds are critical to platelet function in addition to various coagulation co-factors. When antiphospholipid antibodies are produced, they interfere with the clotting process. They increase an affected person's risk of developing recurrent inappropriate blood clots (thrombi) in arteries and veins, which can lead to strokes, heart attacks, and/or miscarriages.
Antiphospholipid antibodies are also associated with low platelet counts (thrombocytopenia) and with the risk of recurrent miscarriages (especially in the second and third trimester), premature labor, and pre-eclampsia.
One or more antiphospholipid antibodies have been identified in various conditions. Some examples are:
Use of certain drugs
The presence of phospholipid antibodies in some instances may be temporary and they have been identified in some individuals who have no detectable illnesses.
Antiphospholipid syndrome (APS), also called Hughes syndrome, is a recognized group of signs and symptoms that includes the formation of blood clots, miscarriages, platelet deficiency (thrombocytopenia), and the presence of one or more antiphospholipid antibodies. APS can be primary with no underlying autoimmune disorder or secondary, existing with a diagnosed autoimmune disorder.
The 14th International Congress on Antiphospholipid Antibodies Task Force criteria for identifying APS requires testing for cardiolipin antibodies, lupus anticoagulant, and beta-2 glycoprotein antibodies when one of two clinical problems exist, blood clots (thrombosis) or pregnancy morbidity.
A blood sample is obtained by inserting a needle into a vein in the arm.
No test preparation is needed.
Antiphospholipid antibody testing is used to help determine the cause of:
Depending on a person's signs and symptoms and medical history, a healthcare practitioner may order one or more of these tests to help detect the presence of antiphospholipid antibodies and/or to help diagnose antiphospholipid syndrome (APS):
If an antiphospholipid antibody is detected, the same test(s) may be repeated 12 weeks later to determine whether their presence is persistent or temporary.
Testing may also be performed to help diagnose and/or evaluate a person with an autoimmune disorder, which can occur along with disorders like lupus. If a person with an autoimmune disorder tests negative for antiphospholipid antibodies, testing may be repeated to determine if an antibody has developed in the course of the disease.
This testing may be ordered when a person has signs and symptoms suggestive of a blood clot (thrombotic episode), such as pain and swelling in the extremities, shortness of breath, and headaches. It also may be ordered when a woman has had recurrent miscarriages and/or as a follow-up to a prolonged PTT test.
When one of the tests is positive, it may be repeated several weeks later to determine whether the antibody is temporary or persistent. Antiphospholipid testing may be done when clinical signs suggest the presence of antiphospholipid syndrome.
When a person with a diagnosed autoimmune disorder tests negative for antiphospholipid antibodies, one or more of the tests may be repeated at regular intervals to screen for the development of an antiphospholipid antibody.
Care must be taken when interpreting the results of antiphospholipid antibody tests. A negative result means only that the specific antibody tested was not present at the time of the test.
Low to moderate levels of one or more antibodies may occur temporarily due to an infection or drug or may appear as a person ages. These levels are often not considered significant but must be examined in conjunction with a person's symptoms and other clinical information.
In some cases, a person may have one or more immunoglobulin classes of a specific antibody present or absent. For instance, the person may have significant quantities of IgG and IgM cardiolipin antibodies or may only be positive for the less frequently tested IgA cardiolipin antibody.
Moderate to high levels of one or more antiphospholipid antibodies, which persist when tested again 12 weeks later, indicate the likely continued presence of that specific antibody.
If tests indicate the presence of the lupus anticoagulant and it persists when retested, then it is likely that the person is positive for the lupus anticoagulant. People who have one or more antiphospholipid antibodies and those that are diagnosed with antiphospholipid syndrome can have an increased risk of having recurrent blood clots, recurrent miscarriages, and/or low platelets (thrombocytopenia).
Test results cannot predict the likelihood of complications, the type, or the severity in a particular person. Some people will have a variety of recurrent problems while others may never experience any difficulties. Examples of this include an asymptomatic individual who is diagnosed with antiphospholipid antibodies following a prolonged PTT test that is done for another reason (such as a pre-surgical screen) and an asymptomatic elderly person who has developed an antiphospholipid antibody.
Transient antiphospholipid antibodies may be seen in people who have inflammation, autoimmune disorders, infections, or cancer.
Occasionally, antiphospholipid antibody testing may be ordered to help determine the cause of a positive VDRL/RPR test for syphilis. The reagents used to test for syphilis contain phospholipids and can cause a false-positive result in those with antiphospholipid antibodies.
False-positive test results may be seen in people who take drugs such as quinidine, procainamide, phenytoin, and penicillin.
No. The process by which these autoantibodies develop is not well understood. There are controllable risk factors, however, such as smoking and obesity that also increase your risk of clotting. Addressing these issues may help to lower your overall risk of developing blood clots but will not prevent the development of antiphospholipid antibodies or get rid of them once they are present.
It is possible, but there is no way to predict when or if this will happen. Antiphospholipid antibody development, and the development of symptoms and complications, varies by individual.
Lupus anticoagulant (LA) is a type of antiphospholipid antibody that interferes with the clotting process in a test tube (so-called anticoagulant) but is associated with excessive clotting (venous or arterial thrombosis) in the body. There is no specific test for LA but is determined by performing a series of tests. For more details, see the article on Lupus Anticoagulant Testing.
General screening is not necessary. Testing is usually only performed if a person has associated signs or symptoms or as a follow up to other testing. Most people will never need to have this testing performed.
Sources Used in Current Review
Berg, T. (Updated 2015 April 15). Antiphospholipid syndrome and pregnancy. Medscape. Available online at http://emedicine.medscape.com/article/261691-overview. Accessed 2/15/2017.
(Reviewed 2016 March 21). Antiphospholipid syndrome. Lupus Foundation of America. Available online at http://www.lupus.org/answers/entry/antiphospholipid-syndrome. Accessed 2/15/2017.
Movva, S. (Updated 2016 July 1). Antiphospholipid syndrome workup. Medscape. Available online at http://emedicine.medscape.com/article/333221-workup. Accessed 2/15/2017.
Moake, J. (Revised 2016 September) Antiphospholipid antibody syndrome. Merck Manual Professional Version. Available online at http://www.merckmanuals.com/professional/hematology-and-oncology/thrombotic-disorders/antiphospholipid-antibody-syndrome-aps. Accessed 2/15/2017.
(Updated 2016 December). Antiphospholipid syndrome – APS. ARUP. Available online at http://www.arupconsult.com/Topics/APS.html?client_ID=LTD. Accessed 2/15/2017.
(© 2016) Antiphospholipid antibodies. The Johns Hopkins Lupus Center. Available online at https://www.hopkinslupus.org/lupus-tests/antiphospholipid-antibodies/. Accessed 2/15/2017.
Fraser, M. and Taylor, W. (© 2016) Antiphospholipid antibody. The University of Rochester Medical Center. Available online at: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=antiphospholipid_antibody. Accessed 2/15/2017.
Gómez-Puerta JA, Cervera R (2014). Diagnosis and classification of the antiphospholipid syndrome. J Autoimmunity 48-49:20-25. Available online at http://www.humberside-rheumatology.uk/assets/antiphospholipid-syndrome---diagnosis-and-classification-j-autoimmunity-2014.pdf. Accessed 2/15/2017.
Bertolaccini ML, et al (2014). 14th International Congress on Antiphospholipid Antibodies Task Force. Report on antiphospholipid syndrome laboratory diagnostics. Autoimmun Rev 13(9):917-930.
Tripodi A. (2007) Laboratory testing for lupus anticoagulants: A review of issues affecting results. Clin Chem 53:9, 1629-1635.
Sources Used in Previous Reviews
Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].
Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby's Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.
(2001 June 26). Antiphospholipid Antibody Syndrome. Hematology Resource Page, Patient Resources University of Illinois - Urbana/Champaign, Carle Cancer Center [On-line information]. Available online at http://www-admin.med.uiuc.edu/hematology/PtAPS.htm.
(© 2004). Antiphospholipid Testing. ARUP's Guide to Clinical Laboratory Testing [On-line information]. Available online at http://www.arup-lab.com/guides/clt/tests/clt_al67.jsp#3965115.
(© 2004). Beta-2 Glycoprotein, Antibody. ARUP's Guide to Clinical Laboratory Testing [On-line information]. Available online at http://www.arup-lab.com/guides/clt/tests/clt_al95.jsp#1145254.
(© 2004). Cardiolipin Antibodies, IgG and IgM. ARUP's Guide to Clinical Laboratory Testing [On-line information]. Available online at http://www.arup-lab.com/guides/clt/tests/clt_a133.jsp#1059158.
Lupus Anticoagulant Panel with Reflex to 1:1 Mixes and Confirmations. ARUP's Guide to Clinical Laboratory Testing [On-line information]. Available online at http://www.arup-lab.com/guides/clt/tests/clt_a52b.jsp#1141319.
Zepf, B. (2002 June 1). A Discussion of the Antiphospholipid Syndrome. American Family Physician, Tips from other Journals, [From Levine JS, et al. The antiphospholipid syndrome. N Engl J Med March 7, 2002;346:752-63] [On-line journal]. Available online at http://www.aafp.org/afp/20020601/tips/11.html.
Petri, M. (2001). Antiphospholipid Antibodies: Anticardiolipin Antibodies and the Lupus Anticoagulant in Systemic Lupus Erythematosus. The Lupus Foundation of America [On-line information]. Available online at http://www.lupus.org/education/brochures/antiphos02.html.
Solenski, N. (2004 April 1). Transient Ischemic Attacks: Part I. Diagnosis and Evaluation. American Family Physician [On-line journal]. Available online at http://www.aafp.org/afp/20040401/1665.html.
The Thrombophilias and Pregnancy. March of Dimes, Professionals and Researchers, Quick References and Fact Sheets [On-line information]. Available online at http://www.marchofdimes.com/professionals/681_9264.asp.
(2001). Antiphospholipid Antibody. Massachusetts General Hospital, Laboratory Medicine, Coag Test Handbood Index [On-line information From: Elizabeth M. Van Cott, M.D., and Michael Laposata, M.D., Ph.D., "Coagulation." In: Jacobs DS et al, ed. The Laboratory Test Handbook, 5th Edition. Lexi-Comp, Cleveland, 2001; 327-358.]. Available online at http://www.mgh.harvard.edu/labmed/lab/coag/handbook/CO003100.htm.
De Moerloose P Antiphospholipid antibodies: do we still need to perform anticardiolipin assays? J Thromb Haemost 2004; 2:1071-1073 and Nash MJ et al.
The anticardiolipin assay is required for sensitive screening for antiphospholipid antibodies. J Thromb Haemost 2004; 2:1077-1081.
Brandt J et al. Criteria fort the diagnosis of Lupus anticoagulants: an update on behalf of the subcommittee on Lupus Antiocoagulant/Antiphospholipids Antibody of the Scientific and Standardization Committee of the ISTH. Thromb Haemost 1995:74:1185-1190.
Wu, A. (2006). Tietz Clinical Guide to Laboratory Tests, Fourth Edition. Saunders Elsevier, St. Louis, Missouri. Pp 134-135.
National Institute of Neurological Disorders and Stroke. NINDS Antiphospholipid Syndrome Information Page. [On-line information. 2007 February 08, Updated.]. Available online at http://www.ninds.nih.gov/disorders/antiphosphlipid/antiphospholipid.htm. Accessed on 4/12/08.
American Heart Association. Antiphospholipid Syndrome (APLS). [On-line information. © 2008).]. Available online at http://www.americanheart.org/presenter.jhtml?identifier=4459. Accessed on 4/12/08.
Belilos, E. and Carsons, S. Antiphospholipid Syndrome. eMedicine [On-line information. 2007 August 10, Updated.]. Available online at http://www.emedicine.com/med/topic2923.htm. Accessed on 4/12/08.
Lupus Foundation of America. Antiphospholipid Antibodies. [On-line information. © 2008.]. Available online at http://www.lupus.org/webmodules/webarticlesnet/templates/new_aboutaffects.aspx?articleid=82&zoneid=17. Accessed on 4/12/08.
APS Foundation of America. Antiphospholipid Antibody Syndrome. [On-line information. 2006 October 15, Revised.]. Available online at http://www.apsfa.org/aps.htm. Accessed on 4/19/08.
ARUP Consult. Antiphospholipid Syndrome – APS. [On-line information. © 2006-2008.]. Available online at http://www.arupconsult.com/Topics/HematologicDz/APS.html#. Accessed on 4/19/08.
National Human Genome Research Institute. Learning About Antiphospholipid Syndrome (APS). [On-line information. 2008 February 5]. Available online at http://www.genome.gov/17516396. Accessed on 4/20/08.
Rodgers, G. et. al. (Updated 2012 November). Antiphospholipid Syndrome – APS. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/APS.html?client_ID=LTD. Accessed January 2013.
(© 2013). Antiphospholipid Antibodies. Lupus Foundation [On-line information]. Available online at http://www.lupus.org/webmodules/webarticlesnet/templates/new_learnaffects.aspx?articleid=2302&zoneid=526. Accessed January 2013.
Hammad, T. (Updated 2012 August 16). Antiphospholipid Antibodies. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/2116457-overview. Accessed January 2013.
Wijetilleka, S. et. al. (2012 September). Novel Insights Into Pathogenesis, Diagnosis and Treatment of Antiphospholipid Syndrome. Medscape Today News from Curr Opin Rheumatol. 2012;24(5):473-481 [On-line information]. Available online at http://www.medscape.com/viewarticle/769627. Accessed January 2013.
Berg, T. (2012 November 21). Antiphospholipid Syndrome and Pregnancy. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/261691-overview. Accessed January 2013.
(2012 May 17). What Is Antiphospholipid Antibody Syndrome? National Heart Lung and Blood Institute [On-line information]. Available online at http://www.nhlbi.nih.gov/health/health-topics/topics/aps/. Accessed January 2013.
(© 1995-2013). Phospholipids, Serum. Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/8296. Accessed January 2013.
(Updated 2010 December 15). Learning About Antiphospholipid Syndrome (APS). National Human Genome Research Institute [On-line information]. Available online at http://www.genome.gov/17516396. Accessed January 2013.
Pagana, K. D. & Pagana, T. J. (© 2011). Mosby's Diagnostic and Laboratory Test Reference 10th Edition: Mosby, Inc., Saint Louis, MO. Pp 71-72.