Search

Introduction: One of the recommended criteria for the laboratory diagnosis of lupus anticoagulants (LA) is demonstration of inhibitory activity. This is confirmed by performing mixing tests with normal plasma, usually in a 1:1 ratio, and demonstrating persistence of an abnormal clotting time in the screening test with significant confirmatory test reduction. However, the mixing with normal plasma can dilute the antibodies to undetectable levels and generate apparent negative results. No guidelines or consensus exist in how to interpret mixing study results., Patients and Methods: The present study assessed the 1:1 mixing study results from 600 patients with a thrombotic history positive for LA demonstrated in neat plasma by individual assays, or combinations, of dilute Russell's viper venom time, dilute activated partial thromboplastin time, activated seven lupus anticoagulant assay and Taipan snake venom time, plus confirmatory tests. Mixing tests were assessed initially using locally derived neat plasma reference ranges and subsequently with mixture specific ranges., Results: The mixture specific ranges had lower upper limits. Of the total LA positive results, 32.5% were positive in the mixing studies when neat plasma reference ranges were applied, and a further 11.2% demonstrated LA activity when using the mixture specific ranges. The remaining 56.3% had been diluted such that they did not elevate the screening test above the upper limit of normal or generated minimal prolongation with an insignificant difference between the screen and confirmatory test result sufficient to confirm LA activity., Conclusions: The significant impact of the dilution effect in 1:1 mixing studies emphasises the limitations of mixing studies as a vehicle for confirmation of inhibition by LA antibodies.

Conflicting data from Western European and USA population studies led us to investigate hyperhomocysteinemia (HHcy), the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphisms and thrombotic disease in North Western Russia. Plasma total homocysteine (tHcy) levels, MTHFR C677T genotype, selected life style determinants and haemostatic factor activity were determined in patients with arterial (n = 33), venous (n = 40), arterial + venous (n = 11) thrombosis and healthy controls (n = 30). We found raised median tHcy levels in all patient groups vs. controls (p < 0.05), with odds ratios (95% CI) for vascular disease among patients with HHcy (defined as > 15 micromol/l) of 3.9 (0.6 - 14.3), 4.8 (1.2 - 18.8) and 15.8 (2.8 - 87.3) respectively. tHcy levels were a function of MTHFR C677T genotype, and all patients with tHcy levels > 30 micromol/l had the MTHFR C677T homozygous substitution. Elevated tHcy levels (p < 0.05) were identified in smokers and coffee drinkers, with the degree of elevation dependent on MTHFR C677T genotype. Of the studied haemostatic parameters increased factor VIII activity and vWF antigen and activity was observed in HHcy subjects. We conclude that HHcy and MTHFR C677T genotype are positively associated with arterial and venous thrombotic disease in the population of North Western Russia.

By the use of a series of monoclonal antibodies against platelet membrane glycoproteins (GP) and the von Willebrand factor (vWF), it is shown that thrombin-induced binding to GP IIb/IIIa involves a different site on vWF from ristocetin-induced binding to GP Ib.

A relatively simple and reproducible chromatographic separation using Dextran Sulphate (DS) Agarose is described for the purification of vWf:Ag from cryoprecipitate or plasma source material. The elution profiles suggest high affinity of vWf for the matrix permitting resolution from Fibrinogen, IgG and the unbound Albumin. The major contaminant fibronectin can be removed prior to the chromatography step by Gelatin-Sepharose adsorption. Chromatography of 125I-vWf, added to cryoprecipitate as a marker, gives two distinct peaks one of which elutes with the column wash through fractions and expresses negligible biological activity. The re-eluted bound material expresses normal vWf:RCo activity with full multimer integrity as assessed by SDS Agarose electrophoresis. DS sepharose chromatography offers an excellent method for the purification of 125I-vWf since all the viable label is resolved from excess free radiolabel and denatured protein. Low recoveries of VIII:C were demonstrated at both R.T. or 4 degrees C possibly due to the presence of Tri-Sodium citrate and the absence of sufficient free CaCl 2 in the buffers.

The applicability of Dextran Sulphate (DS) agarose in the purification of the VIII/vWf complex from cryoprecipitate was investigated. The elution profiles indicate high affinity of the VIII/vWf complex for the matrix. With application of combined salt/pH gradients good resolution of VIII/vWf from most of the applied proteins can be achieved. VIII/vWf normally elutes as a single component (70-90% vWf:Ag and vWf:RCo) with modest yields of factor VIII (30-40%) VIII:C and 50-70% VIII:Ag) providing calcium ions are present. Addition of L-lysine, Histidine and Arginine (all 1.0M) inhibit binding of proteins to the matrix. Alternatively, higher yields of VIII:C can be obtained (80% VIII:C and 100% VIII:Ag) by the application of L-lysine gradients (0-0.6M) but with loss of resolution from Fn and slight dissociation of VIII:C from vWf:Ag.