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Sepiashvili L, Bohn MK, Hall A, Henderson T, Chen J, Dunst R, Adeli K. Determination of pediatric reference limits for 10 commonly measured autoantibodies. Clin Chem Lab Med 2022; 60:1839-1846. [PMID: 36117138 DOI: 10.1515/cclm-2022-0675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/30/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this study was to establish pediatric reference limits for autoimmune disease markers in the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) cohort of healthy children and adolescents to support their interpretation and clinical decision making. The CALIPER is a national study of healthy children aiming to close gaps in pediatric laboratory medicine by establishing a robust database of pediatric reference intervals for pediatric disease biomarkers (caliperdatabase.org). METHODS Healthy children and adolescents (n=123, aged 1-19) were recruited to CALIPER with informed consent. Serum autoantibody testing conducted on the BIO-FLASH analyzer (Werfen, Barcelona, Spain) included anti-dsDNA IgG, anti-Sm IgG, anti-RNP IgG, anti-SSB/La IgG, anti-Ro60 IgG, anti-Ro52 IgG, anti-cardiolipin IgG, anti-MPO IgG, anti-PR3 IgG, and anti-tTG IgA. Pediatric reference limits representing 95th, 97.5th, and 99th percentiles were calculated using the non-parametric rank method according to Clinical Laboratory Standards Institute C28-A3 guidelines. RESULTS The proportion of samples with results above the lower limit of the analytical measuring range were: anti-cardiolipin IgG 90%, anti-dsDNA 22%, anti-Sm 13%, anti-RNP 0.8%, anti-SSB/La 0%, anti-Ro60 0%, anti-Ro52 0%, anti-MPO 25%, anti-PR3 9%, and anti-tTG IgA 28%. Pediatric reference limits and associated 90% confidence intervals were established for all 10 markers. All autoantibodies could be described by one age range except for anti-cardiolipin IgG and anti-MPO. A sex-specific difference was identified for anti-tTG IgA. CONCLUSIONS Robust pediatric reference limits for 10 commonly clinically utilized autoimmune markers established herein will allow for improved laboratory assessment and clinical decision making in pediatric patients using the BIO-FLASH assay platform worldwide.
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Affiliation(s)
- Lusia Sepiashvili
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Molecular Medicine, SickKids Research Institute, Toronto, ON, Canada
| | - Mary Kathryn Bohn
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Alexandra Hall
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Tina Henderson
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jack Chen
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Roseline Dunst
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Khosrow Adeli
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Molecular Medicine, SickKids Research Institute, Toronto, ON, Canada
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Devreese KMJ, de Groot PG, de Laat B, Erkan D, Favaloro EJ, Mackie I, Martinuzzo M, Ortel TL, Pengo V, Rand JH, Tripodi A, Wahl D, Cohen H. Guidance from the Scientific and Standardization Committee for lupus anticoagulant/antiphospholipid antibodies of the International Society on Thrombosis and Haemostasis: Update of the guidelines for lupus anticoagulant detection and interpretation. J Thromb Haemost 2020; 18:2828-2839. [PMID: 33462974 DOI: 10.1111/jth.15047] [Citation(s) in RCA: 181] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/14/2020] [Accepted: 07/31/2020] [Indexed: 12/13/2022]
Abstract
This guidance focuses on methodological aspects of lupus anticoagulant (LA) testing, as well as interpretation of results for clinicians. The main changes in how to test for LA compared with the International Society on Thrombosis and Haemostasis Scientific and Standardization Committee 2009 guidelines, in the preanalytical phase are more detailed recommendations on how to handle testing in anticoagulated patients, and the timing of testing. Also, routine coagulation tests are advised to obtain more information on the coagulation background of the patient, and when necessary, anti-Xa activity measurement for heparins or specific assays for direct oral anticoagulants should be performed. The three-step procedure with two test systems (diluted Russell's viper venom time and activated partial thromboplastin time [aPTT]) is essentially not changed. Silica remains the preferable activator in the aPTT assays, but ellagic acid is not excluded. We advise simultaneous performance of the mixing and confirmatory step, in each sample with a prolonged screening test. The confirmatory step can also be performed on a mixture of patient plasma and normal pooled plasma. Cutoff values should be established in-house on at least 120 normals, with transference of the manufacturer's cutoffs as an alternative. Reporting of results has not been changed, although more attention is focused on what clinicians should know. Patient selection for LA testing has been expanded.
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Affiliation(s)
- Katrien M J Devreese
- Coagulation Laboratory, Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Philip G de Groot
- Synapse Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bas de Laat
- Synapse Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Emmanuel J Favaloro
- Department of Haematology, Sydney Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Ian Mackie
- Haemostasis Research Unit, Research Haematology Department, University College London, London, UK
| | - Marta Martinuzzo
- Laboratorio Central del Hospital Italiano de Buenos Aires, Departamento de Bioquímica Aplicada, Instituto Universitario del Hospital Italiano, Buenos Aires, Argentina
| | - Thomas L Ortel
- Division of Hematology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Vittorio Pengo
- Thrombosis Research Laboratory, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Jacob H Rand
- Department of Pathology & Laboratory Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Armando Tripodi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Cà Granda Maggiore Policlinico Hospital Foundation, Milano, Italy
- Fondazione Luigi Villa, Milano, Italy
| | - Denis Wahl
- Vascular Medicine Division and Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Nancy University Hospital, Nancy, France
- INSERM UMR-S 1116, University of Lorraine, Nancy, France
| | - Hannah Cohen
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
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Vanoverschelde L, Kelchtermans H, Musial J, de Laat B, Devreese KMJ. Influence of anticardiolipin and anti-β2 glycoprotein I antibody cutoff values on antiphospholipid syndrome classification. Res Pract Thromb Haemost 2019; 3:515-527. [PMID: 31294336 PMCID: PMC6611479 DOI: 10.1002/rth2.12207] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/05/2019] [Accepted: 03/13/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Anticardiolipin (aCL) and anti-β2 glycoprotein I (aβ2GPI) immunoglobulin (Ig) G/IgM antibodies are 2 of the 3 laboratory criteria for classification of antiphospholipid syndrome (APS). The threshold for clinically relevant levels of antiphospholipid antibodies (aPL) for the diagnosis of APS remains a matter of debate. The aim of this study was to evaluate the variation in cutoffs as determined in different clinical laboratories based on the results of a questionnaire as well as to determine the optimal method for cutoff establishment based on a clinical approach. METHODS The study included samples from 114 patients with thrombotic APS, 138 patients with non-APS thrombosis, 138 patients with autoimmune disease, and 183 healthy controls. aCL and aβ2GPI IgG/IgM antibodies were measured at 1 laboratory using 4 commercial assays. Assay-specific cutoff values for aPL were obtained by determining 95th and 99th percentiles of 120 compared to 200 normal controls by different statistical methods. RESULTS Normal reference value data showed a nonparametric distribution. Higher cutoff values were found when calculated as 99th rather than 95th percentiles. These values also showed a stronger association with thrombosis. The use of 99th percentile cutoffs reduced the chance of false positivity but at the same time reduced sensitivity. The decrease in sensitivity was higher than the gain in specificity when 99th percentiles were calculated by methods wherein no outliers were eliminated. CONCLUSIONS We present cutoff values for aPL determined by different statistical methods. The 99th percentile cutoff value seemed more specific. However, our findings indicate the need for standardized statistical criteria to calculate 99th percentile cutoff reference values.
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Affiliation(s)
- Laura Vanoverschelde
- Coagulation LaboratoryDepartment of Laboratory MedicineGhent University HospitalGhentBelgium
| | - Hilde Kelchtermans
- Synapse Research InstituteMaastrichtThe Netherlands
- Department of BiochemistryMaastricht UniversityCardiovascular Research Institute MaastrichtMaastrichtThe Netherlands
| | - Jacek Musial
- Department of MedicineJagiellonian University Medical CollegeKrakowPoland
| | - Bas de Laat
- Synapse Research InstituteMaastrichtThe Netherlands
- Department of BiochemistryMaastricht UniversityCardiovascular Research Institute MaastrichtMaastrichtThe Netherlands
| | - Katrien M. J. Devreese
- Coagulation LaboratoryDepartment of Laboratory MedicineGhent University HospitalGhentBelgium
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Bor MV, Jacobsen ILS, Gram JB, Sidelmann JJ. Revisiting the Phadia/EliA cut-off values for anticardiolipin and anti-β2-glycoprotein I antibodies: a systematic evaluation according to the guidelines. Lupus 2018; 27:1446-1454. [PMID: 29848159 DOI: 10.1177/0961203318776105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Phadia/EliA fluorescence enzyme immunoassays are widely used automated assays for anticardiolipin (aCL) and anti-β2-glycoprotein I (aβ2GPI) antibodies. To date, cut-off values for these assays have not been evaluated systematically and the evidence behind manufacturer's recommended cut-off values is not clear. Objective To determine Phadia/EliA cut-off values for antiphospholipid antibodies (aPL) according to the procedures suggested by guidelines. Methods A total of 266 blood donors (135 females and 131 males) were included. The pre-handling and analysis of the samples were performed according to the International Society on Thrombosis and Hemostasis (ISTH) guideline for solid phase aPL assays. Cut-off values and corresponding 90% confidence intervals (CI) for each antibody were established and outliers were handled according to the Clinical and Laboratory Standards Institute (CLSI) guideline for reference intervals. Samples from 377 consecutive patients, referred to our thrombophilia center with evidence of thrombosis or pregnancy morbidity were included for aPL testing. Results The in-house 99th (97.5th) percentile cut-off values were 11 (8.7), 12 (6.9) 8.5 (5.0) AU/mL for aβ2GPI IgG, IgM and IgA, and 21 (13) GPL-U/mL and 41 (25) MPL-U/mL for aCL IgG and IgM, respectively. The prevalence of positive results (%) defined by these cut-off values in patients with evidence of thrombosis or pregnancy morbidity was 9.5 (12.2), 1.6 (2.9), and 7.0 (9.9), and 0.8 (3.8) for aβ2GPI IgG, IgM, and aCL IgG and IgM respectively. The use of in-house 99th percentile cut-off values compared to the manufacturer suggested cut-off values resulted in 1 and 39 fewer samples for aβ2GPI and aCL to be classified as positive for aPL, respectively. Conclusions We present Phadia/EliA cut-off values with 90% CI for aPL determined systematically according to the ISTH and CLSI guidelines. These values are different from values previously determined, suggesting variation of aPLs in different populations. Our findings indicate the need for each laboratory to determine/validate assay specific cut-off values for aPL.
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Affiliation(s)
- M V Bor
- 1 Department of Clinical Biochemistry, Hospital of South West Denmark, Esbjerg, Denmark
| | - I-L Søtang Jacobsen
- 1 Department of Clinical Biochemistry, Hospital of South West Denmark, Esbjerg, Denmark
| | - J B Gram
- 1 Department of Clinical Biochemistry, Hospital of South West Denmark, Esbjerg, Denmark.,2 Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - J J Sidelmann
- 1 Department of Clinical Biochemistry, Hospital of South West Denmark, Esbjerg, Denmark.,2 Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
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Manukyan D, Rossmann H, Schulz A, Zeller T, Pfeiffer N, Binder H, Münzel T, Beutel ME, Müller-Calleja N, Wild PS, Lackner KJ. Distribution of antiphospholipid antibodies in a large population-based German cohort. Clin Chem Lab Med 2017; 54:1663-70. [PMID: 27028736 DOI: 10.1515/cclm-2016-0014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 02/20/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Antiphospholipid syndrome (APS) is the most common acquired thrombophilia. Diagnosis is based on clinical criteria and the presence of antiphospholipid antibodies (aPLs) above the 99th percentile of a reference group. Data on the distribution of aPL in the population are limited. The distribution of aPL including diagnostic cutoffs should be determined in a population-based cohort. METHODS The Gutenberg Health Study (GHS) is a population-based cohort aged 35-74 years. We determined the presence of antibodies against cardiolipin (aCL, IgG, and IgM), β2-glycoprotein I (anti-β2GPI, IgG, and IgM), and domain 1 of β2-glycoprotein I (anti-domain 1, IgG) in a sample of 4979 participants. RESULTS aPL titers were similar in the whole sample and in an apparently healthy subgroup of 1049 individuals. There was a strong age-dependent increase of both aCL and anti-β2GPI IgM, while aPL IgG titers were stable or tended to decrease with age. A relevant decrease was observed for aCL IgG in women and anti-domain 1 IgG in both sexes. There was no association of aPL titers with a history of venous thromboembolism (VTE). CONCLUSIONS Our data show that for IgM aPL, age-dependent reference ranges should be used. In fact, the controversy regarding the clinical utility of IgM aPL might be related to the use of inappropriate reference ranges among other causes. In our population, aPLs were not associated with a history of VTE.
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Chen YC, Chi LM, Chow KC, Chiou SH, Fan YH, Ho SP, Hsu YC, Hwang YC, Wu MX, Lee WM, Lin SL, Tsang CL, Mao FC. Association of anticardiolipin, antiphosphatidylserine, anti-β2 glycoprotein I, and antiphosphatidylcholine autoantibodies with canine immune thrombocytopenia. BMC Vet Res 2016; 12:106. [PMID: 27297331 PMCID: PMC4906605 DOI: 10.1186/s12917-016-0727-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 06/07/2016] [Indexed: 11/10/2022] Open
Abstract
Background In humans, the presence of antiphospholipid antibodies (aPL) is frequently found in immune thrombocytopenia. The present study investigated whether aPL and any aPL subtypes are associated with canine thrombocytopenia, in particular, immune-mediated thrombocytopenia (immune thrombocytopenia) that usually manifests with severe thrombocytopenia. Results Sera were collected from 64 outpatient dogs with thrombocytopenia (Group I, platelet count 0 – 80 × 103/uL), and 38 of which having severe thrombocytopenia (platelet count < 30 × 103/uL) were further divided into subgroups based on the presence of positive antiplatelet antibodies (aPLT) (subgroup IA, immune thrombocytopenia, n =20) or the absence of aPLT (subgroup IB, severe thrombocytopenia negative for aPLT, n =18). In addition, sera of 30 outpatient dogs without thrombocytopenia (Group II), and 80 healthy dogs (Group III) were analyzed for comparison. Indirect ELISAs were performed to compare serum levels of aPL subtypes, including anticardiolipin antibodies (aCL), antiphosphatidylserine antibodies (aPS), antiphosphatidylcholine (aPC), and anti-β2 glycoprotein I antibodies (aβ2GPI), and antiphosphatidylinositol antibodies (aPI), among different groups or subgroups of dogs. Among outpatient dogs, aCL, being highly prevalent in outpatient dogs with thrombocytopenia (63/64, 98 %), is an important risk factor for thrombocytopenia (with a high relative risk of 8.3), immune thrombocytopenia (relative risk 5.3), or severe thrombocytopenia negative for aPLT (relative risk ∞, odds ratio 19). In addition, aPS is a risk factor for immune thrombocytopenia or severe thrombocytopenia negative for aPLT (moderate relative risks around 2), whereas aPC and aβ2GPI are risk factors for immune thrombocytopenia (relative risks around 2). Conclusions Of all the aPL subtypes tested here, aCL is highly associated with canine thrombocytopenia, including immune thrombocytopenia, severe thrombocytopenia negative for aPLT, and less severe thrombocytopenia. Furthermore, aPS is moderately associated with both canine immune thrombocytopenia and severe thrombocytopenia negative for aPLT, whereas aβ2GPI, and aPC are moderately relevant to canine immune thrombocytopenia. In contrast, aPI is not significantly associated with canine immune thrombocytopenia. Electronic supplementary material The online version of this article (doi:10.1186/s12917-016-0727-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yu-Chen Chen
- Graduate Institute of Microbiology and Public Health, National Chung Hsing University, Taichung, 40227, Taiwan, Republic of China
| | - Lang-Ming Chi
- Department of Medical Research and Development Linko Branch, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan, Republic of China.,Molecular Medical Research Center, Chang Gung University, Taoyuan, 333, Taiwan, Republic of China
| | - Kuan-Chih Chow
- Graduate Institute of Biomedical Sciences, National Chung Hsing University, Taichung, 40227, Taiwan, Republic of China
| | - Shiow-Her Chiou
- Graduate Institute of Microbiology and Public Health, National Chung Hsing University, Taichung, 40227, Taiwan, Republic of China.
| | - Yi-Hsin Fan
- Graduate Institute of Microbiology and Public Health, National Chung Hsing University, Taichung, 40227, Taiwan, Republic of China
| | - Shu-Peng Ho
- Department of Veterinary Medicine, National Chung Hsing University, Taichung, 40227, Taiwan, Republic of China
| | - Yu-Chen Hsu
- Graduate Institute of Microbiology and Public Health, National Chung Hsing University, Taichung, 40227, Taiwan, Republic of China
| | - Yu-Chyi Hwang
- Graduate Institute of Microbiology and Public Health, National Chung Hsing University, Taichung, 40227, Taiwan, Republic of China
| | - Meng-Xing Wu
- Department of Veterinary Medicine, National Chung Hsing University, Taichung, 40227, Taiwan, Republic of China
| | - Wei-Ming Lee
- Department of Veterinary Medicine, National Chung Hsing University, Taichung, 40227, Taiwan, Republic of China.,Veterinary Medical Teaching Hospital, National Chung Hsing University, Taichung, 40227, Taiwan, Republic of China
| | - Shiun-Long Lin
- Department of Veterinary Medicine, National Chung Hsing University, Taichung, 40227, Taiwan, Republic of China.,Veterinary Medical Teaching Hospital, National Chung Hsing University, Taichung, 40227, Taiwan, Republic of China
| | - Chau-Loong Tsang
- Department of Veterinary Medicine, National Chung Hsing University, Taichung, 40227, Taiwan, Republic of China
| | - Frank Chiahung Mao
- Department of Veterinary Medicine, National Chung Hsing University, Taichung, 40227, Taiwan, Republic of China
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Willis R, Pierangeli SS, Jaskowski TD, Malmberg E, Guerra M, Salmon JE, Petri M, Branch DW, Tebo AE. Performance Characteristics of Commercial Immunoassays for the Detection of IgG and IgM Antibodies to β2 Glycoprotein I and an Initial Assessment of Newly Developed Reference Materials for Assay Calibration. Am J Clin Pathol 2016; 145:796-805. [PMID: 27267373 DOI: 10.1093/ajcp/aqw065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To investigate the performance characteristics and impact of newly developed reference calibrators on the commutability between anti-β2 glycoprotein I (anti-β2 GPI) immunoassays in antiphospholipid syndrome (APS) and/or systemic lupus erythematosus (SLE). METHODS Immunoglobulin G (IgG) and immunoglobulin M (IgM) anti-β2 GPI immunoassays from four manufacturers were evaluated. Serum samples from 269 patients (APS only, n = 31; SLE and APS, n = 83; SLE only, n = 129; pregnancy-related clinical manifestations without APS, n = 26) and 162 women with histories of successful pregnancies were tested. Results were expressed in kit-specific arbitrary units and in the calibrator reference units (RUs) based on 99th percentile cutoff values. Diagnostic accuracies, correlation between kits, and specific clinical manifestations in APS were investigated. RESULTS The sensitivities of the assays ranged from 15.8% to 27.2% (IgG) and 12.3% to 15.8% (IgM) while specificities ranged from 79.4% to 86.5% (IgG) and 80.6% to 84.5% (IgM). There was moderate to almost perfect interassay reliability (Cohen κ, 0.69-0.98), and Spearman correlation coefficients were generally improved when results of the IgG determinations were expressed in RUs. CONCLUSIONS Although qualitative agreements between immunoassays for both antibody isotypes are acceptable, correlations with APS clinical manifestations were kit dependent. Only the use of IgG reference material improved quantitative correlations between assays.
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Affiliation(s)
- Rohan Willis
- From Rheumatology/Internal Medicine, University of Texas Medical Branch, Galveston
| | - Silvia S Pierangeli
- From Rheumatology/Internal Medicine, University of Texas Medical Branch, Galveston
| | - Troy D Jaskowski
- ARUP Institute of Clinical and Experimental Pathology, Salt Lake City, UT
| | - Elisabeth Malmberg
- ARUP Institute of Clinical and Experimental Pathology, Salt Lake City, UT
| | - Marta Guerra
- Rheumatology, Hospital for Special Surgery, New York, NY
| | - Jane E Salmon
- Rheumatology, Hospital for Special Surgery, New York, NY
| | - Michelle Petri
- Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - D Ware Branch
- Maternal Fetal Medicine, University of Utah and Intermountain Healthcare, Salt Lake City
| | - Anne E Tebo
- ARUP Institute of Clinical and Experimental Pathology, Salt Lake City, UT Department of Pathology, University of Utah, Salt Lake City.
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Montaruli B, De Luna E, Erroi L, Marchese C, Mengozzi G, Napoli P, Nicolo' C, Romito A, Bertero MT, Sivera P, Migliardi M. Analytical and clinical comparison of different immunoassay systems for the detection of antiphospholipid antibodies. Int J Lab Hematol 2016; 38:172-82. [PMID: 26847159 DOI: 10.1111/ijlh.12466] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/04/2015] [Indexed: 12/27/2022]
Abstract
INTRODUCTION We evaluated analytical and clinical performances of IgG and IgM anticardiolipin (aCL) antibodies and anti-β2-glycoprotein I (a-β2GpI) antibodies and upper limit reference ranges (99th percentiles) in comparison with manufacturer's cutoff values with different commercial methods. METHODS We assayed aCL and a-β2GpI in serum samples from 30 healthy individuals, 77 patients with antiphospholipid syndrome (APS) diagnosed according to the Sydney criteria, 51 patients with autoimmune diseases, eight patients with previous thrombotic events, six patients with other diseases, and 18 patients with infectious diseases, using ELISA Inova Diagnostics; EliA Phadia Laboratory Systems; CliA Zenit-RA; and CliA Bio-Flash. RESULTS Anticardiolipin and a-β2GpI IgG and IgM immunoassays showed good analytic performances with both 99th percentile and manufacturer's cutoff reference values. Our results showed fair to moderate agreement among assays. In-house cutoff values gave significantly better performances only for a-β2GpI IgG with all the immunoassays analyzed with the exception of Inova CliA Bio-Flash where we obtained the same performances with in-house and manufacturer's cutoffs. CONCLUSIONS By guidelines, all laboratories are strongly advised to validate/verify the manufacturer's cutoff values. We recommend establishing low-positive, medium-/high-positive, and high-positive CliA IgG aCL and a-β2GpI ranges in order to help clinicians in the diagnosis and treatment of APS.
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Affiliation(s)
- B Montaruli
- Laboratory Analysis, AO Ordine Mauriziano, Torino, Italy
| | - E De Luna
- Laboratory Analysis, AO Ordine Mauriziano, Torino, Italy
| | - L Erroi
- Laboratory Analysis, AO Ordine Mauriziano, Torino, Italy
| | - C Marchese
- Laboratory Analysis, AO Ordine Mauriziano, Torino, Italy
| | - G Mengozzi
- Laboratory Analysis, Città della Salute e della Scienza, Torino, Italy
| | - P Napoli
- Laboratory Analysis, AO Martini, Torino, Italy
| | - C Nicolo'
- Laboratory Analysis, AO San Luigi Orbassano, Torino, Italy
| | - A Romito
- Laboratory Analysis, AO Maria Vittoria, Torino, Italy
| | - M T Bertero
- Clinical Immunology, AO Ordine Mauriziano, Torino, Italy
| | - P Sivera
- Haematology, AO Ordine Mauriziano, Torino, Italy
| | - M Migliardi
- Laboratory Analysis, AO Ordine Mauriziano, Torino, Italy
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Mattia E, Ruffatti A, Meneghel L, Tonello M, Faggian D, Hoxha A, Fedrigo M, Punzi L, Plebani M. A contribution to detection of anticardiolipin and anti-β2glycoprotein I antibodies: Comparison between a home-made ELISA and a fluorescence enzyme immunoassay. Clin Chim Acta 2015; 446:93-6. [PMID: 25892672 DOI: 10.1016/j.cca.2015.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 04/02/2015] [Accepted: 04/08/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Currently, ELISA for detection of anticardiolipin (aCL) and anti-β2glycoprotein I (anti-β2GPI) antibodies is not standardized. Recently, few studies have compared the performance of ELISA with that of fluorescence enzyme immunoassay (FEIA), but they have produced debatable results. The aim of this investigation was to compare ELISA with FEIA results in detecting aCL and anti-β2GPI antibodies. METHODS The study cohort included 94 primary antiphospholipid syndrome (PAPS) patients, 65 subjects with the clinical criteria for PAPS classification but ELISA negative for the laboratory criteria and 165 control subjects. Serum IgG/IgM aCL/anti-β2GPI antibodies were determined using FEIA-EliA™ and a home-made ELISA. RESULTS The sensitivities of the two methods were similar with the exception of IgM aCL which was found to be significantly higher in the PAPS patients using the ELISA method, even if IgM aCL was detected at a low level by both techniques. The two assays had a comparable specificity, a high/significant agreement and a significant correlation between the antibody levels. FEIA testing uncovered no significant prevalence of any antiphospholipid (aPL) antibody in the ELISA negative patients. CONCLUSION Our results suggest that FEIA is comparable to a home-made ELISA.
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Affiliation(s)
- Elena Mattia
- Rheumatology Unit, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
| | - Amelia Ruffatti
- Rheumatology Unit, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Lauro Meneghel
- Rheumatology Unit, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Marta Tonello
- Rheumatology Unit, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Diego Faggian
- Laboratory Medicine Unit, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Ariela Hoxha
- Rheumatology Unit, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Marny Fedrigo
- Department of Cardiologic, Thoracic, and Vascular Sciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Leonardo Punzi
- Rheumatology Unit, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Mario Plebani
- Laboratory Medicine Unit, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
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