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lupus-like anticoagulant testing


nziegler

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We perform dRVVT testing for lupus-like anticoagulant/antiphospholipid testing.  We automatically run both the screen and confirm, then report a normalized ratio.  For any ratio >=1.20 a comment is added to the report saying, "Evidence of a lupus anticoagulant (antiphospholipid antibody) is detected ... blah blah blah."  Our new hematopathologist would like for us to change the wording because it sounds too definitive - ISTH guidelines recommend performing at least two methods and to have testing repeated at 12 weeks to definitively call an antiphospholipid antibody.  I agree with her, so I'm wondering what (if any) comment any of you that perform this testing attach to the result?

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We only reflex to a confirm if the screen is positive. If the LNR is >1.2 we then report as "Possible Lupus anticoagulant, please repeat in 12 weeks for confirmation.". This eliminates any acute phase patients which may be falsely positive - they aren't the best with the clinical details.

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We run the DRVVT test from IL.  We report out the test as positive if the confirm ratio is over 1.20, and automatically order, and have run at our reference lab, a hexogonal phase test. 

Whether the result is pos or neg, we assume that the physician knows all of the implications of what is essentially a screening test, as they should for most other test results.

Scott

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