A simple procedure that increases the specificity of the activated protein C resistance test in samples containing antiphospholipid antibodies.
It is well known that plasmas with lupus anticoagulants (LA) may give false low activated protein C (APC) ratios, and these false positive tests are not necessarily corrected by mixing with factor V deficient plasma (FVdef). In the present study, we show that repeating the test after mixing 1 + 1 with pooled normal plasma (NP) instead of mixing with FVdef confirm the presence of the Leiden mutation (FV-Leiden) in patients with antiphospholipid antibodies (APA). Samples from sixteen patients with a low APC-ratio were examined. Eight samples contained APAs, including five samples with LA.


RESULTS
The APC-ratios of eleven samples, including four with APAs, became normal when retested after mixing the plasma 1 + 1 with NP. All of them were heterozygous for FV-Leiden. One additional patient, who had partial correction of the APC-ratio, proved to be homozygous for the Leiden mutation. The remaining four samples, all of which had high positive tests for APAs, remained unchanged. One of these four was heterozygous for FV-Leiden, while the other three had normal FV.


CONCLUSIONS
Normalisation of a low APC-ratio after dilution 1 + 1 with NP confirms the diagnosis of FV-Leiden. PCR analysis could be reserved for cases not affected by this procedure.
Jacobsen
E M
EM
Haematological Research Laboratory, Ullevål University Hospital, Oslo, Norway.
Wisløff
F
F
D017152:Antibodies, Antiphospholipid / Q000097:blood*; D001778:Blood Coagulation Disorders / Q000097:blood* / Q000175:diagnosis; D004351:Drug Resistance; D005165:Factor V / Q000032:analysis; D005166:Factor V Deficiency / Q000097:blood* / Q000175:diagnosis*; D005189:False Positive Reactions; D006801:Humans; D016682:Lupus Coagulation Inhibitor / Q000097:blood; D010314:Partial Thromboplastin Time; D011486:Protein C / Q000378:metabolism* / Q000494:pharmacology*; D012680:Sensitivity and Specificity
D017152:Antibodies, Antiphospholipid; D016682:Lupus Coagulation Inhibitor; D011486:Protein C; C095381:factor V Leiden; D005165:Factor V