lupus-antikoagulant (LH Indholdsside)

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      <HtmlField Name="PageContent"><![CDATA[<h2>Resum&eacute;</h2>
<ul>
    <li>Lupus Antikoagulans (LA) er antistoffer, der binder fosfolipider og proteiner i cellemembraner. Antistofferne&nbsp;binder protrombin og &oslash;ger kl&oslash;vningen til det aktive trombin. Derfor er LA associeret med &oslash;get risiko for ven&oslash;se og arterielle tromboser og med recidiverende aborter</li>
    <li>P&aring;visning af LA er et af laboratoriekriteriene for&nbsp;<a href="~/link.aspx?_id=A652908C64E94A5CA3B55B3DD9BCA76B&amp;_z=z">antifosfolipid syndrom</a>. Skal v&aelig;re p&aring;vist 2 gange med mindst 12 ugers interval for at udelukke kortvarig tilstedev&aelig;relse af LA induceret af infektion eller medikament</li>
    <li>B&oslash;r vurderes sammen med resultater p&aring;&nbsp;<a href="~/link.aspx?_id=EBCCED0F591D4F9F86A9BD27C20D60FE&amp;_z=z">anticardiolipin antistoffer</a>&nbsp;og/eller Anti-&beta;2 glykoprotein I antistof</li>
    <li>Findes hos ca. 30 % af patienterne med systemisk lupus erytematosus</li>
</ul>
<h2>Definition</h2>
<ul>
    <li>Lupus antikoagulans er antistoffer, der binder fosfolipider og proteiner i cellemembranen. Kaldes fosfolipidantistoffer&nbsp;<a href="/EditorPage.aspx?da=core&amp;id=%7B4F4F2378-F219-49B5-A5E2-7282EDE41FB6%7D&amp;ed=FIELD3082593916&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H3082594308&amp;us=sitecore%5Clefr&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Winter WE, Flax SD, Harris NS, Coagulation Testing in the Core Laboratory. Lab Med 2017;48: 295-313" data-value-piped="Winter WE, Flax SD, Harris NS|Coagulation Testing in the Core Laboratory.|Lab Med|2017|48|295-313|29126301" data-url="reference-link" data-pubmedid="29126301" title="Winter WE, Flax SD, Harris NS, Coagulation Testing in the Core Laboratory. Lab Med 2017;48: 295-313">1</a>&nbsp;</li>
    <li>Lupus antikoagulans forl&aelig;nger koagulationstiden (APTT og tilsvarende test) in vitro (heraf navnet)</li>
    <li>Navnet Lupus anticoagulans er misvisende, da antistofferne oftest er protrombotiske i patienten</li>
</ul>
<h2>Synonymer</h2>
<ul>
    <li>&nbsp;Lupus antikoagulant, LA&nbsp;</li>
</ul>
<h2>Aktuelle indikationer<a href="https://dsth.dk/pdf/Trombofiliretningslinje_Maj_2020_Web.pdf" data-type="other-reference" data-value="Retningslinje om udredning for Trombofili, DSTH 2020 " data-url="https://dsth.dk/pdf/Trombofiliretningslinje_Maj_2020_Web.pdf" title="Retningslinje om udredning for Trombofili, DSTH 2020 ">2</a>,<a href="EditorPage.aspx?da=core&amp;id=%7B4F4F2378-F219-49B5-A5E2-7282EDE41FB6%7D&amp;ed=FIELD1252857817&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H1252857881&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="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" data-value-piped="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|33462974" data-url="reference-link" data-pubmedid="33462974" title="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">3</a></h2>
<ul>
    <li>Mistanke om erhvervet eller arvelig trombofili. Indg&aring;r i trombofiliscreening&nbsp;<a href="EditorPage.aspx?da=core&amp;id=%7B4F4F2378-F219-49B5-A5E2-7282EDE41FB6%7D&amp;ed=FIELD1252857817&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H1252857881&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="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" data-value-piped="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|33462974" data-url="reference-link" data-pubmedid="33462974" title="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">3</a>,<a href="EditorPage.aspx?da=core&amp;id=%7B4F4F2378-F219-49B5-A5E2-7282EDE41FB6%7D&amp;ed=FIELD2714965536&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H2714965809&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Linnemann B, Hart C, Laboratory Diagnostics in Thrombophilia. Hamostaseologie 2019;39: 49-61" data-value-piped="Linnemann B, Hart C|Laboratory Diagnostics in Thrombophilia.|Hamostaseologie|2019|39|49-61|30703819" data-url="reference-link" data-pubmedid="30703819" title="Linnemann B, Hart C, Laboratory Diagnostics in Thrombophilia. Hamostaseologie 2019;39: 49-61">4</a></li>
    <li>Recidiverende aborter f&oslash;r uge 10, intrauterin fosterd&oslash;d eller v&aelig;ksth&aelig;mning, pr&aelig;term f&oslash;dsel (f&oslash;r uge 34), pr&aelig;eklampsi&nbsp;</li>
    <li>Indg&aring;r i de diagnostiske kriterier for&nbsp;<a href="~/link.aspx?_id=A652908C64E94A5CA3B55B3DD9BCA76B&amp;_z=z">antifosfolipid syndrom</a>&nbsp;
    <ul>
        <li>Skal v&aelig;re p&aring;vist 2 gange med 12 ugers interval</li>
        <li>Rekvireres almindeligvis sammen med&nbsp;<a href="~/link.aspx?_id=EBCCED0F591D4F9F86A9BD27C20D60FE&amp;_z=z">anticardiolipin antistoffer</a>&nbsp;og/eller Anti-&beta;2 glykoprotein I antistof</li>
    </ul>
    </li>
    <li>Vurdering af tromboserisiko hos patienter med&nbsp;<a href="~/link.aspx?_id=68262A579C404E3B83DEDB66EB738254&amp;_z=z">systemisk lupus erytematosus</a></li>
</ul>
<h2>Fortolkninger</h2>
<ul>
    <li>P&aring;visning af LA er et af laboratoriekriteriene for <a href="~/link.aspx?_id=A652908C64E94A5CA3B55B3DD9BCA76B&amp;_z=z">antifosfolipid syndrom</a>. Skal v&aelig;re p&aring;vist 2 gange med mindst 12 ugers interval for at udelukke kortvarig tilstedev&aelig;relse af LA induceret af infektion eller medikament.&nbsp;</li>
    <li>B&oslash;r vurderes sammen med resultater p&aring;&nbsp;<a href="~/link.aspx?_id=EBCCED0F591D4F9F86A9BD27C20D60FE&amp;_z=z">anticardiolipin antistoffer</a>&nbsp;og/eller Anti-&beta;2 glykoprotein I antistof</li>
    <li>Findes hos ca. 30 % af patienterne med systemisk lupus erytematosus</li>
    <li>Resultater skal fortolkes med nedenst&aring;ende fejlkilder in mente</li>
</ul>
<h2>Fejlkilder (og kilder til normal variation)</h2>
<ul>
    <li>AK-behandling med vitamin K-antagonister og hepariner (ogs&aring; lavmolekyl&aelig;re hepariner) interferer med analysemetoden og kan resultere i fejlagtig p&aring;visning af Lupus antikoagulans. Dette g&aelig;lder ogs&aring; for de nye antitrombotiske midler, s&aring;vel de direkte trombinh&aelig;mmere som faktor Xa h&aelig;mmere. Konferer med klinisk biokemisk afd.</li>
    <li>Pr&oslash;ven kan ikke tages under p&aring;g&aring;ende antikoagulationsbehandling</li>
    <li>Ved akutte events i forbindelse med pr&oslash;vetagningen kan akut fase reaktanter (FVIII og CRP) give falsk-negative/falsk-positive resultater</li>
    <li>Graviditet kan resultere i falsk-positive/falsk-negative resultater og b&oslash;r fortolkes forsigtigt. B&oslash;r gentages post partum mindst efter 6 uger og helst efter 3 m&aring;neder</li>
</ul>
<h2>Biokemisk baggrund</h2>
<ul>
    <li>P&aring;visning af Lupus antikoagulant b&oslash;r detekteres efter internationale retningslinjer i et to-test system (diluted Russell's viper venom tid og activated partial thromboplastin tid [aPTT] <a href=" " data-type="journal-reference" data-value="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" data-value-piped="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|33462974" data-url="reference-link" data-pubmedid="33462974" title="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">3</a></li>
    <li>Lupus antokoagulans er et uspecifikt fosfolipid antistof&nbsp;</li>
    <li>Antistofferne binder til Protrombin og &oslash;ger dermed kl&oslash;vningen til det aktive Trombin med &oslash;get trombosetendens&nbsp;</li>
    <li>&AElig;tiologi er ukendt, men er associeret til
    <ul>
        <li>en lang r&aelig;kke sygdomme (autoimmune lidelser, cancer, infektioner, non-maligne h&aelig;matologiske sygdomme)</li>
        <li>Medicinudl&oslash;st (eksempelvis Phenytoin, Hydralazin, Chlorpromazine, Procainamide)</li>
    </ul>
    </li>
</ul>
<h2>Pr&oslash;vetagning</h2>
<ul>
    <li>Citrat-plasma (citratr&oslash;r, lysebl&aring; prop)</li>
    <li>Skal centrifugeres indenfor en time efter pr&oslash;vetagning og kan derfor ikke tages i praksis&nbsp;</li>
    <li>Patienten b&oslash;r IKKE v&aelig;re i AK-behandling</li>
    <li>I forbindelse med tromboser og udredning af disse skal pr&oslash;ven tages f&oslash;r AK-behandling p&aring;begyndes eller&nbsp;efter at AK- behandling har v&aelig;ret seponeret i 3 uger</li>
    <li>Pr&oslash;vetagning p&aring; ambulante patienter foretages i Ambulatoriet p&aring; Klinisk Biokemisk Afdeling</li>
</ul>
<h2>Referenceintervaller</h2>
<ul>
    <li>Svar afgives som Negativ eller Positiv</li>
</ul>
<h2>NPU-koder og -navne</h2>
<ul>
    <li>NPU02616 P&mdash;Lupus antikoagulans; arb.k.(proc.) = ?</li>
    <li>NPU22255 P&mdash;Koagulation, russelaktivase X-induceret; rel.tid(uden/med phospholipid-inkub.; proc.) = ?</li>
    <li>NPU02616 P&mdash;Lupus antikoagulans; arb.k.(proc.) = ?</li>
</ul>
<h3>Kort navn</h3>
<ul>
    <li>Lupus antikoagulans;P&nbsp;</li>
    <li>Lupus antikoagulans (LA1/LA2);P</li>
    <li>Lupus antikoagulans;P</li>
</ul>
<h2>Vurdering af unormalt pr&oslash;vesvar</h2>
<ul>
    <li>Positiv test er associeret med &oslash;get risiko for arterielle og ven&oslash;se tromboser, og med tromboserelaterede komplikationer i svangerskab</li>
    <li>Ca. 30 % af patienter med systemisk lupus erytematosus udvikler lupus antikoagulant og derved &oslash;get risiko for tromboser</li>
</ul>
<h2>Opf&oslash;lgning af unormalt pr&oslash;vesvar</h2>
<ul>
    <li>Specialistopgave</li>
    <li>Aktuelt med antitrombotisk medikamentel behandling</li>
    <li>Kr&aelig;ver behandling og n&oslash;je opf&oslash;lgning under svangerskab</li>
    <li>Infektioner og enkelte l&aelig;gemidler kan give forbig&aring;ende positiv test</li>
</ul>]]></HtmlField>
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