Distinguishing lupus anticoagulants from factor VIII inhibitors in haemophilic and non-haemophilic patients

Haemophilia : the Official Journal of the World Federation of Hemophilia
A G RampersadA Shapiro

Abstract

Accurate diagnosis of an inhibitor, a neutralizing antibody to infused factor VIII (FVIII), is essential for appropriate management of haemophilia A (HA). Low-titre inhibitors may be difficult to diagnose due to high rates of false-positive inhibitor results in that range. Transient low-titre inhibitors and false-positive inhibitors may be due to the presence of a lupus anticoagulant (LA) or other non-specific antibodies. Fluorescence immunoassay (FLI) to detect antibodies to FVIII is a sensitive method to identify inhibitors in HA. Evaluations of antibody profiles by various groups have demonstrated that haemophilic inhibitors detected by Nijmegen-Bethesda (NBA) and chromogenic Bethesda (CBA) assays correlate with positivity for anti-FVIII immunoglobulin (Ig) G1 and G4. This study sought to determine whether FLI could distinguish false-positive FVIII inhibitor results related to LAs from clinically relevant FVIII inhibitors in HA patients. Samples from haemophilic and non-haemophilic subjects were tested for LA, specific FVIII inhibitors by NBA and CBA, and anti-FVIII immunoglobulin profiles by FLI. No samples from LA-positive non-haemophilic subjects were positive by FLI for anti-FVIII IgG4. Conversely, 91% of NBA-positive sa...Continue Reading

References

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Citations

Nov 21, 2020·Haemophilia : the Official Journal of the World Federation of Hemophilia·Brian BoylanConnie H Miller
Feb 2, 2022·Hämostaseologie·Jens MüllerUNKNOWN Standing Commission Labor (STAEKOLA) of the Society of Thrombosis and Haemostasis Research (GTH)

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