Geisinger Medical Laboratories Test Catalog

Order Display Name: Geisinger Epic Procedure Code Or ID CPT Code:  

LUPUS ANTICOAGULANT PROFILE WITH INTERPRETATION BY PATHOLOGIST

ORDERING INFORMATION:
Geisinger Epic Procedure Code: LAB2625         Geisinger Epic ID: 26810

SPECIMEN COLLECTION
Specimen type:
 Platelet-free plasma AND serum.
Preferred collection container:
Alternate Collection Container:
Other size blue-top (3.2% sodium citrate) tubes (e.g., 1.8 mL, 4.5 mL)
6 mL red-top (plain, non-serum separator) tube
Specimen required:
Eight (8), 1 mL plasma aliquots AND 0.5 mL serum
Special notes:
  • Ideally the patient should not be receiving anticoagulant medication as it may interfere with testing and cause erroneous results. See Anticoagulation Impact on Coagulation Tests.
  • If the patient’s hematocrit (HCT) is >55%, the volume of anticoagulant in the tube should be adjusted. Contact a performing location for special tube preparation to reduce the citrate in the collection tube. For those patients with HCT >65.4% see LAB3632 Stago Sodium Citrate Adjustment Chart for formula to determine amount of citrate removal required.
  • When possible, use fresh venipuncture to collect blood to avoid activation of coagulation by tissue thromboplastin. Blood may be drawn from an indwelling catheter or vascular access device. Draw sample from a lumen that has not been heparinized or flush the line with 5 ml of saline, and discard or use the first 5-10 mL of blood for other purposes.
  • Tubes should be >90% filled.
  • Immediately mix gently after collection by inverting the tube end over end 5 to 6 times. Avoid vigorous mixing or additional inversion. Observe for the presence of clots. Recollect if fibrin clots observed.
  • Transport at ambient temperature to processing location and processing should be completed within 4 hours.
  • Butterfly device collections, draw a discard tube first to remove air from collection tubing.
Patient preparation:
 Antiphospholipid antibody testing immediately after a thrombotic event is discouraged. Patient should be off all anticoagulation prior to collection as follows:
Heparin- 48 hours
Coumadin- 2 weeks
Direct thrombin or Xa inhibitors- 7 days
Anti-platelet medication- no need to stop
SPECIMEN PROCESSING
Specimen processing instructions:
Centrifuge blue top specimens immediately at designated time and speed to obtain platelet-poor plasma (<10,000/µL). Using a plastic pipette, carefully remove plasma from cells, avoiding platelet/buffy layer by leaving a thin layer of plasma on top the cells. The centrifuged plasma should be aliquoted (1 mL per aliquot) into clearly labeled polypropylene tubes. Eight (8) plasma aliquots needed. Check the residual specimen for clot and if present discard sample and redraw specimen. Freeze upright and transport on dry ice.

Allow serum to clot. Centrifuge and submit 0.5 mL serum.

 
Transport temperature:
 Plasma aliquots: Frozen
Serum: Refrigerated
Specimen stability:
 Plasma room temperature: 4 hours
Plasma frozen -20°C: 2 weeks
Plasma frozen -70°C: 6 months

Serum room temperature: 8 hours
Serum refrigerated 2-8°C: 48 hours
Serum frozen: 6 months
Rejection criteria:
 Clotted, hemolyzed, improperly filled tubes, improper anticoagulant ratio (HCT >55% and citrate not adjusted), refrigerated specimens, or stability exceeded. Note: Specimen suspected of thawing in transport, indicated by slant in aliquot or specimen in lid of tube, will have testing performed, and the comment “interpret results with caution as thawing suspected” added to results.
TEST DETAILS
Reference interval:
 Dilute Russel viper venom screen ratio: ≤ 1.20, Negative for lupus anticoagulant
Lupus sensitive APTT screen ratio: 0.91-1.40, Negative for lupus anticoagulant
Beta-2 glycoprotein IgG antibody: Negative < 7 U/mL
Beta-2 glycoprotein IgM antibody: Negative < 7 U/mL
Cardiolipin IgG: Negative < 10 GPL-U/mL
Cardiolipin IgM: Negative <10 MPL-U/mL
Additional information:
 Testing includes interpretation with report. Lupus anticoagulant workflow.
CPT code(s):
 85613, 85730, 86147 x2, 86146 x2, and either 80503, 80504, or 80505 (depending on complexity), If reflex testing needed the following may be added depending on lupus profile algorithm: 85613, 85730, 85525, 85610, 85597, 85670, 85520, 85384
Note: The billing party has sole responsibility for CPT coding.  Any questions regarding coding should be directed to the payer being billed.  The CPT codes provided by GML are based on AMA guidelines and are for informational purposes only.
Test includes:
 Lupus sensitive APTT (PTT-LA) screen, dilute Russel's viper venom time (DRVVT) screen, IgG and IgM beta-2-glycoprotein antibodies, IgG and IgM anticardiolipin antibodies, and pathologist interpretation. If PTT-LA or DRVVT screen abnormal reflex testing is performed if indicated. Reflex testing includes thrombin time, unfractionated heparin (anti-Xa level), heparin neutralization, PTT-LA and DRVVT mixing studies, DRVVT Confirmation and PTT-LA with platelet neutralization.

Lupus Anticoagulant Profile Workflow

Methodology:
Mechanical clot-based
Chromogenic
Enzyme Immunoassay (EIA)
Synonyms:
LUP, lupus inhibitor, lupus anticoagulant, antiphospholipid antibody
Clinical significance:
Antiphospholipid antibodies are immunoglobins that bind protein-phospholipid complexes in the body. Most antiphospholipid antibodies arise from infection, drugs (including antibiotics, phenothiazine, hydralazine, quinine, calcium channel blockers, procainamide, phenytoin, cocaine), or elevated estrogens and disappear within 12 weeks. These are transient and are of no clinical consequence.

Autoimmune antiphospholipid antibodies can be detected in patients with systemic lupus erythematous, rheumatoid arthritis, scleroderma, and Sjogren syndrome or may arise spontaneously, known as antiphospholipid antibody syndrome. These antibodies are more likely to persist and are associated with a higher risk of thrombosis (blood clots), recurrent pregnancy complications, and low platelet counts.

Antiphospholipid antibodies include lupus anticoagulant, detected by clot-based testing (PTT-LA or DRVVT), and anticardiolipin antibodies and anti-beta-2 glycoprotein antibodies detected by immunoassay.

Antiphospholipid antibody testing immediately after a thrombotic event is discourage. Anticoagulant therapy and ongoing or recent thrombotic events interfere with interpretation of lupus testing. If anticoagulation is detected the test will be resulted with a comment stating anticoagulation detect and indeterminant for lupus anticoagulant.

If a lupus anticoagulant is detected it may interfere with other clot-based testing including PT INR, APTT, factor studies, and mixing studies.

Doctoral Director(s:)
Michelle Grant DO    
Review Date: 03/28/2023

Performing Locations

Geisinger Medical Center

Performing laboratory: Coagulation
Technical Lead: Margaret Knowles-Tuchman
Frequency: First shift, twice weekly
Performed STAT? No
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