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Lupus Anticoagulant (LAC)

• Introduction
• Indications for Testing
• Detection Method
• Interpretation of Test Results
• Specimen Collection and Shipping Requirements
• Turn around Time
• Cost
• Request Hard Copy
• References

Introduction
Lupus-like Anticoagulant (LAC) has been linked to a variety of clinical findings, including arterial and venous thromboembolic events, thrombocytopenia and recurrent pregnancy loss. LAC is an antiphospholipid antibody directed against negatively charged phospholipids that is identified functionally by prolongation of in vitro phospholipid-dependent coagulation tests such as Activated Partial Thromboplastin Time (APTT), Prothrombin Time (PT) or dilute Russell's Viper Venom Time (dRVVT). IL TestTM LAC Screen and IL TestTM LAC Confirm are dRVVT reagents used in the detection of LAC because they are more specific tests for the evaluation of LAC that APTT or PT. The prevalence of LAC in patients with a history of recurrent pregnancy loss varies between 1 to 5% depending on the population studies. Among pregnancies in which no treatment is given, 86% are complicated by embryonic or fetal loss.

Indications for Testing
All individuals with a history of arterial or venous thrombosis, lupus erythematosus or the presence of elevated antiphospholipid antibodies as well as all women experiencing two or more pregnancy losses should be screened for the presence of a circulating LAC. If the results of the screening test are elevated, the presence of LAC should be confirmed through the performance of the dRVVT.

Detection Method
Lupus-like Anticoagulant (LAC) is detected using dRVVT. dRVVT in the presence of calcium directly activated Factor X in the test sample. IL TestTM LAC Screen and IL TestTM LAC Confirm are unaffected by contact factor abnormalities and factor VII deficiency or inhibitors. Heparin interference is neutralized using polybrene. As a result, IL TestTM LAC Screen and IL TestTM LAC Confirm are more specific tests for the evaluation of LAC than APTT or PT.

Interpretation of Test Results
The final result is expressed by a ratio of IL TestTM LAC Screen / IL TestTM LAC Confirm:

Specimen Collection and Shipping Requirements

• Collect plasma from a one (1) blue top tube.
• Spin, separate, freeze and ship in prepaid FedEx mailers overnight, next day morning.

Turn around Time
Processing of specimens begins immediately upon receipt at our facilities. Results are routinely available within 7 to 10 days and are initially faxed, then mailed to the requesting physician.

Cost
Included in our fees are specimen collection and shipping materials, all courier and shipping charges, telephone and written reports, and consultation with physicians. Please call 1-877-737-7652 for pricing information.

Request Hard Copy

References
Coulam CB, Kaider BD, Kaider AS, Janowicz RG. Roussev RG. Antiphospholipid antibodies associated with implantation failure after IVF/ET. J Assist Reprod Genet 1997; 14:603-8.

Coulam CB. The role of antiphospholipid antibodies in reproduction: questions answered and raised at the 18th annual meeting of the American Society of Reproductive Immunology. Am J Reprod Immunol 1999; 41:1-4.

Kaider AS, Kaider BD, Janowicz PB, Roussev RG. Immunodiagnostic evaluation in women with reproductive failure. Am J Reprod Immunol 1999; 42: 335-346.

Sher G, Zouves C, Feinman M, Maassarani G, Matzner W, Chong P, Ching W.A rational basis for the use of combined heparin/aspirin and IVIG immunotherapy in the treatment of recurrent IVF failure associated with antiphospholipid antibodies. Am J Reprod Immunol 39:391-94.

Sher G, Matzner W, Feinman M, Maassarani G, Zouves C, Chong P, Ching W. The selective use of heparin/aspirin therapy, alone or in combination with intravenous immunoglobulin G, in the management of antiphospholipid antibody-positive women undergoing in vitro fertilization. Am J Reprod Immunol. 1998; 40:74-82.