Testing for antiphospholipid antibodies at autopsy

Authors: Bartosz Hudzik Janusz Szkodzinski Lech Polonski

Publish Date: 2014/01/17

Volume: 10, Issue: 2, Pages: 288-289

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Abstract

Certain issues require further consideration when testing for antiphospholipid antibodies APLAs particularly when the tests are to be carried out during autopsy 1 2 3 First and foremost laboratory tests must be positive on at least two different occasions at least 12 weeks apart 4 We have to keep in mind that APLAs may appear transiently or persistently in a wide variety of clinical conditions and even in healthy individuals 5 Testing for APLAs on only one occasion may lead to false conclusions 1 Positive results often cause unjustified concern and conversely a negative test may provide false reassurance 2Furthermore an appropriate time of testing is one of the most important variables that should always be considered because the acute phase of thrombosis and anticoagulant therapy may considerably affect the results of many assays making interpretation of the results difficult and unreliable 6 7 As a general rule tests should be postponed for 3–6 months after the acute phase of thrombosis 4 5 6 8 Given that the presence of lupus anticoagulant is determined via a coagulometric assay there are strict guidelines for its detection Numerous variables can affect assays used for lupus anticoagulant detection 9 10 Optimal laboratory detection of lupus anticoagulant includes proper blood sample collection the use of appropriate screening mixing and confirmatory tests and proper expression of the obtained results 9 As the preanalytical phase blood collection double centrifugation quick sample freezing is pivotal we are unaware whether the assays used for lupus anticoagulant detection have been validated for postmortem blood collection and analysisSince APS is an acquired condition testing for APLAs at autopsy for presumed implications for family members seems futile The condition has scarcely been reported to run in families however it does not have a clear pattern of inheritance Multiple factors environmental and perhaps genetic are likely to play a part in the risk of developing APS 5 11There are some reports implicating APLAs in the formation and progression of atherosclerotic lesions 5 Notwithstanding as more is learned about the natural history of the development of atherosclerosis it is clear that the process that results in morbidity and mortality in adults has its origins in childhood and adolescence 12 So the presence of atherosclerosis in young adults should not be considered as a manifestation of APS since it is one of the least specific APS clinical pictures Rather it would appear that the increasing prevalence of traditional risk factors such as hypertension dyslipidemia smoking and diabetes mellitus are important in the early stages of the processFinally thrombophilia screening is expensive and timeconsuming in clinical practice It is natural for clinicians to want to look for the cause of thrombosis However it is only generally recommended that thrombophilia testing is performed where the management of the patient will be altered by the results thereby calling into question the ancillary benefits of APS testing at autopsy 2 13

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