title: Antiphospholipid syndrome: a clinical and laboratorial challenge.
abstract: Antiphospholipid syndrome (APS) is an acquired autoimmune thrombophilia characterized by the presence of a heterogeneous family of antibodies that bind to plasma proteins with affinity for phospholipid surfaces. The two major protein targets of antiphospholipid antibodies are prothrombin and β2-glycoprotein I (β2GPI). APS leads to aprothrombotic state, and it is characterized by the occurrence of arterial, venous or microvascular thrombosis or recurrent fetal loss. The diagnosis of APS is based on a set of clinical criteria and the detection of lupus anticoagulant (LA), anticardiolipin antibodies (ACA) or anti-β2GPI in plasma. Although laboratory tests are essential for APS diagnosis, these tests have limitations associated with the robustness, reproducibility and standardization. The standardization of diagnostic tests for detection of APLAs has been a challenge and a variety of results have been obtained using different commercial kits and in-house techniques. An increased sensitivity of the ELISA kits for detection of ACA effectively has contributed to APS diagnosis. However, the lack of specificity associated with a high number of false-positive results is a clinical and laboratorial challenge, since such results may lead to mistaken clinical decisions, such as prescription of oral anticoagulant, leading to the risk of hemorrhaging. Furthermore, clinicians are often unfamiliar with these tests and have difficulty interpreting them, requiring interaction between clinical and laboratory professionals in order to ensure their correct interpretation.
authors.affiliation: Department of Clinical and Toxicological Analyses, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Luci Maria Santana
authors.initials: LM
authors.lastname: Dusse
authors.affiliation: Department of Clinical and Toxicological Analyses, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Fernanda Dias e
authors.initials: FD
authors.lastname: Silva
authors.affiliation: Department of Clinical and Toxicological Analyses, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Letícia Gonçalves
authors.initials: LG
authors.lastname: Freitas
authors.affiliation: Federal University of São João Del-Rei, São João Del Rei, MG, Brazil.
authors.forename: Danyelle Romana Alves
authors.initials: DR
authors.lastname: Rios
authors.affiliation: Federal University of São João Del-Rei, São João Del Rei, MG, Brazil.
authors.forename: Sandra Cristina
authors.initials: SC
authors.lastname: Armond
authors.affiliation: Medical Clinic Department, Faculty of Pharmacy Medical School, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Milena Soriano
authors.initials: MS
authors.lastname: Marcolino
mesh_terms: D017153:Antibodies, Anticardiolipin / Q000097:blood*; D016736:Antiphospholipid Syndrome / Q000175:diagnosis* / Q000276:immunology; D019411:Clinical Laboratory Techniques / Q000379:methods; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D006801:Humans; D016682:Lupus Coagulation Inhibitor / Q000097:blood*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D053482:beta 2-Glycoprotein I / Q000097:blood*
chemical_list: D017153:Antibodies, Anticardiolipin; D016682:Lupus Coagulation Inhibitor; D053482:beta 2-Glycoprotein I