Background Examining patients with clinical features of the antiphospholipid-antibody-syndrome (APS), anticardiolipin antibodies (aCL) and lupus anticoagulant (LA) tests are widely performed. Unfortunately some patients with typical symptoms of APS (i.e. thromboembolic and ischaemic events, pregnancy losses) have negative test results in the commonly performed assays.
Methods Using a new ELISA-test-system (Aesku.lab Diagnostika GmbH, Wendelsheim, Germany) we examined sera of 102 patients (68 women, 34 men) with clinical symptoms of APS: 61 patients had a history of thromboembolic events, 44 of cerebrovascular insults, 6 women had pregnancy losses. The assay detects IgG- and IgM-class-antibodies against Phosphatidyl-Serine (PS), Phosphatidyl-Inositol (PI), Sphingomyelin (SM), Phosphatidyl-Ethanolamine (PE) and Phosphatidyl-Choline (PC) without cofactor and in combination with b2-glycoprotein I (b2-GP-I) respectively.
Results Sera of 50 patients were completely negative in the LA- and aCL-tests, 17 patients had only low concentrations of aCL-antibodies. Of this 67 patients with negative or borderline results in the commonly performed tests, 39 (58%) were positive for other phospholipid-antibody-specificities, in 22 (33%) the antibody-concentrations were even high. Antibodies which were tested positive in 10 or more patients are shown in the table, every “+” indicates one patient.
Conclusion As shown in the table, most of the phospholipid-antibody-specificities found in patients with negative or borderline results in LA- and aCL-tests are IgM-class antibodies independent from b2-glycoprotein I. Testing for these antibodies could be helpful for the diagnostic of patients with clinical features of the APS and negative results in the commonly performed tests, especially if there are no further risk factors for thromboembolic events or ischaemic insults.
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