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  • Help Deciphering test results

    I am lucky; about or within a week of getting any blood work done the results are posted on a website for me to view. Normally they are quite self-explanatory or easily explained with abit of googling. This last one though, is giving me a headache.

    I'll try to look it up more later; but if any of you with more experience can help explain it to me I would be very appreciative. I know it at least got me a referral to Rheumatology- where I now have an appointment on the 8th. The nurse on the phone said that Rheumatology Doctor would go over the results then, but I'd like to know more now if possible.


    The Results:
    Lupus Anitcoagulant SEE NOTE

    Reference Range:
    A Lupus Anticoagulant is detected since one of the two
    confirmatory tests is positive.
    Lupus Anticoagulants (LA) may be associated with thrombotic
    events, recurrent abortion, or may be asymptomatic. A
    bleeding history requires other coagulopathies be excluded.
    Since LA may be transient, international consensus
    guidelines suggest waiting at least 12 weeks before
    retesting to confirm antibody persistence.(J Thromb Haemost
    2006:4;295).
    This interpretation is based
    on the following test results:

    PTT-LA
    133 sec
    Reference Range: < OR = 40

    Hexagonal Phase Neutralization POSITIVE
    Reference Range: NEGATIVE

    DRVVT Screen 80 sec
    Reference Range: < OR = 42

    Phospholipid Neutralization NEGATIVE
    Reference Range: NEGATIVE

    dRVVT Mix Interpretation TNP
    Reference Range: < OR = 42
    TNP-Reflex testing not required.

    Cardiolipin Ab Screen NEGATIVE
    Reference Range: NEGATIVE

    Cardiolipin Ab IgA TNP

    <10 Negative
    10-15 Equivocal
    16-40 Positive - Uncertain risk factor;
    may be reactive
    >40 Positive - Risk factor for thrombosis
    and pregnancy loss
    <10 Negative
    10-15 Equivocal
    16-40 Positive - Uncertain risk factor;
    may be reactive
    >40 Positive - Risk factor for thrombosis
    and pregnancy loss

    TNP-Anti-cardiolipin screen result negative; reflex testing
    not performed. On occasion, a cardiolipin screen will yield
    positive results which are not confirmed by the more
    specific individual cardiolipin isotype assays. The screen
    technology is constructed to capture all possible
    cardiolipin positive sera. The highly specific individual
    cardiolipin IgM, IgG and IgA assays are used to confirm the
    true positive cardiolipin screen specimens, and to rule out
    those cardiolipin screen positive specimens that may be
    attributed to other undefined reactants.
    Clinical Significance:
    The Antiphospholipid Antibody Syndrome (APS) is a clinical
    pathologic correlation that includes a clinical event (e.g.
    thrombosis, pregnancy loss, thrombocytopenia) and persistent
    positive Antiphospholipid Antibodies (IgM or IgG ACA >40
    MPL/GPL, IgM or IgG anti-B2GP1 antibodies, or a Lupus
    Anticoagulant). The IgA isotype has been implicated in
    smaller studies, but have not yet been incorporated into the
    APS criteria. International consensus guidelines suggest
    waiting at least 12 weeks before retesting to confirm
    antibody persistence. Reference J Thromb Haemost 2006: 4;
    295.
    <10 Negative
    10-15 Equivocal
    >15 Positive

    ~~~
    See why I'm a little confuzzled? lol Thanks again!
    Last edited by Kareena; 03-01-2010, 11:31 PM.

  • #2
    Okay; now that I've had a little time, this is what I found out. All this seems to say is that I have Lupus Anti-bodies in my system; which I was already informed about. I don't get why this really changes much other than supporting the data from the first time I was tested. While I am glad the Doctor referred me- why did this make any difference?

    If anyone has any additional information I would love to hear it and/or your experiences. Thank you!

    ~~~
    PTT-LA: 133
    It's high, but this is most likely due to me being on Coumadin(a blood thinner) for recent blood clots in my lungs. If you are not on a blood thinner and it's high like mine; you may have clotting issues with your blood.
    Reference: http://www.labtestsonline.org/unders...aptt/test.html


    Hexagonal Phase Neutralization: POSITIVE
    Basically means I have Lupus Antibodies in my blood stream. It is NOT a diagnosis of Lupus- it can be an indicator but lots of people have Lupus Antibodies that do not have lupus. It is what is most likely the reason I've had so many mis-carriages and can be a contributor to thrombosis.
    Reference: http://laboratoryalliance.com/pdf/He...20Mar%2009.pdf


    DRVVT Screen: 80 sec
    Seems to be an addition test to back up the conclusion that I have Lupus Antibodies in my system. Though the 1st test *could* have been a false positive since I was on heparin in the hospital- coumadin does not contribute to false positives. So this second test should be accurate and support the data from the 1st test. (The first time tested I was in the hospital and I don't have access to those results)
    Reference: http://www.labtestsonline.org/unders...lant/test.html


    Phospholipid Neutralization: NEGATIVE
    A negative result means only that the specific antibody tested was not present at the time of the test. This one was hard to find information on.
    Reference: http://www.labtestsonline.org/unders...pids/test.html


    dRVVT Mix Interpretation:TNP- Means "Test Not Preformed"


    Cardiolipin Ab Screen: NEGATIVE
    A negative result means only that the cardiolipin antibody class tested (IgG, IgM, and/or IgA) is not present at this time.
    Reference: http://www.labtestsonline.org/unders...ipin/test.html


    Cardiolipin Ab IgA: TNP- Means "Test Not Preformed"
    Last edited by Kareena; 03-01-2010, 11:59 PM.

    Comment


    • #3
      Your Partial Thromboplastin Time, hexagonal phase neutralization and Dilute Russell Viper Venom Time (tests related to Lupus Anticoagulant) have come back positive. However in order to be a true positive they need to be retested in 12 weeks (sometimes only 6 weeks) and if they are positive again you will be considered to be positive for Lupus anticoagulant. (Cardiolipin and APS are negative). Is this what you were after?

      Comment


      • #4
        Originally posted by diamonds View Post
        Your Partial Thromboplastin Time, hexagonal phase neutralization and Dilute Russell Viper Venom Time (tests related to Lupus Anticoagulant) have come back positive. However in order to be a true positive they need to be retested in 12 weeks (sometimes only 6 weeks) and if they are positive again you will be considered to be positive for Lupus anticoagulant. (Cardiolipin and APS are negative). Is this what you were after?
        Okay; I guess I see then why the doctor is now taking this more seriously. I got my first tests done in the hospital about Dec 15th. And these tests were done Feb 24th- not quite 12 weeks but close. So now they are considered "true positive" and that is why they are finally referring me you think?

        Comment


        • #5
          Yes it is most likely why you have had many miscarriages and recent blood clots in your lungs.

          Comment


          • #6
            and yes that is why they are taking it more seriously and referring you. Sometimes 6 weeks is often considered adequate time to retest as well in order to determine a true positive.

            Comment


            • #7
              Thank you Diamonds for your reply. I appreciate the help in getting this all figured out in my head.

              Comment


              • #8
                You're welcome

                Comment


                • #9
                  Hi there,

                  I'm not going to go into trying to interpret blood test results as they are extremely complex and need more than the explanation provided by the lab but I just wanted to say that (confusingly) the lupus anticoagulant test is NOT a test for lupus. It is a test for APS (or Hughe's disease or sticky blood) a blood clotting disorder - but I am wondering if you don't already have that diagnosis as you are already on blood thinners?

                  It can be present in people who have SLE (about 30%) but people can also have APS as a stand-alone disease. As a previous poster mentioned, for an APS diagnosis, you need to test positive in two separate blood tests and have a clotting event (which you have had).

                  These are just general observations. From looking at one of your first posts it seems that you have pretty complicated blood problems anyway so it would be hard to be more than very general here.

                  It is good that you now have that rheumatology referral where they should be able to tell more about whether you have APS alone or APS and lupus.

                  Bye for now,

                  Katharine

                  Comment


                  • #10
                    I read this thread late last night but decided not to even attempt to reply until this morning until my brain was a bit clearer and I might make some practical sense.
                    I have a few comments to make arising from all this, helpful ones I hope.

                    We get confused because it is all very complicated and that's why we need expert doctors to sort things out. At the same time it is important to be well informed for a number of reasons I won't go into here

                    I have Lupus Anti-bodies
                    The lupus anticoagulant is so named because these antibodies were first identified in patients with lupus. They are called antiphospholipid antibodies and might not have anything at all to do with lupus. They are only one sort of of thousands maybe millions of antibodies and thousands maybe millions of autoantibodies associated with autoimmune diseases of all sorts. AP ab's are not always autoantibodies. I believe as many people have APS without having lupus as have APS along with lupus

                    Speaking generally, two sorts of testing are done to determine if antiphospholipid antibodies are detectable. They are the various clotting tests done for the so called lupus anti coagulant and tests for anticardiolipins. Both tests need to be done at the same time because at any given time either might give normal, false- negative, results. Both tests are usually repeated at an interval of at least 6 weeks. This is because the findings might be abnormal temporarily for reasons that have nothing to do with chronic disease. There are also a number of other blood diseases that have to do with separate abnormal blood clotting factors

                    False positives can arise for a number of reasons including chronic infectious diseases ( eg Lyme, HIV/AIDS, syphilis). There's at least one test that can show if the cause of abnormal findings is autoimmune. Abnormal results can be a criterion for a diagnosis of lupus.
                    ACR Classification Criteria List:

                    Immunologic disorder
                    a) Anti- ds-DNA: antibody to native DNA in abnormal titer
                    OR
                    B) Anti-Sm: presence of antibody to Sm nuclear antigen
                    OR
                    c) False positive serologic test for syphilis known to be positive for at least 6 months and confirmed by Treponema pallidum immobilization or fluorescent treponemal antibody absorption test
                    d) Positive finding of antiphospholipid antibodies based on 1) an abnormal serum level of IgG or IgM anticardiolipin antibodies, 2) a positive test result for lupus anticoagulant using a standard method, or 3) a false-positive serologic test for syphilis known to be positive for at least 6 months and confirmed by Treponema pallidum immobilization or fluorescent treponemal antibody absorption test.
                    I notice that it doesn't say that the LAC and anti cardiolipins have to be tested two times at an interval. Maybe once would be enough for a lupus diagnositic criterion depending on the doctor's evaluation habits and taking into account other test results and symptoms.

                    If there have already been frequent miscarriages ( ) or other clotting events, then I would guess it's a question of determining if the cause of the events was indeed these APL abs and then considering if they could be associated with lupus, assuming there are symptoms that could not be explained by PAPS, primary antiphospholipid syndrome.

                    In such a case it would be normal to be referred to a rheumatologist preferably one specialising in autoimmune connective tissue diseases like lupus. Familiarity with RA isn't enough. Tests for the auto antibodies associated with lupus will be done.

                    I don't know how the LAC clotting tests and especially the ACL ab test results are affected by taking Coumadin or other blood thinners. I might be quite wrong but I can't see that it matters much in a case like yours, not at this stage anyway.

                    There's a very fine line between being as informed as one needs to be at any particular stage, and trying to diagnose oneself. It's very easy to jump to false conclusions.

                    Let us know how you get on please and good luck!

                    Clare
                    Last edited by Clare.T; 03-02-2010, 11:22 AM.

                    Comment


                    • #11
                      Sorry Kareena i should have clarified that the Lupus Anticoagulant being positive does not mean that you have Lupus. What i meant is that your doctors are probably taking your blood clots in your lungs more seriously (and your background of recurrent miscarriage) due to the presence of the lupus anticoagulant. It got confusing as we both posted within minutes of each other. I was only commenting on your result and not the likelihood of you having lupus. I hope i didn't confuse you.

                      Comment


                      • #12
                        No; I was well aware of that from the very beginning of learning about the anti-body. But thanks.

                        Comment

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