Heterogeneity of lupus anticoagulant (LA) antibodies: LA activity in dilute Russell's Viper Venom Time and dilute Kaolin Clotting Time detect different populations of antibodies in patients with the "antiphospholipid" syndrome

Antiphospholipid (aPL) antibodies comprise two main groups of antibodies, lupus anticoagulant (LA) antibodies and "anticardiolipin" (aCL) antibodies which can be separated by certain chromatographic techniques. In this study we analysed the plasma of 10 patients with aPL antibodies. and were able to demonstrate that in four patients with both clotting test reactivities, the dilute Russell's Viper Venom Time (dRVVT) activity can be separated from the dilute Kaolin Clotting Time (dKCT) reactivity by using a polyacrylamide-immobilised phosphatidylserine column but not with phospholipid liposomes. The differential reactivity of the autoantibodies in this patient population is not due to binding to beta 2GPI, prothrombin or protein C in solid-phase immunoassays. Hence LA antibodies detected in different phospholipid dependent clotting tests detect different populations of antibodies in some APS patients and the routine detection of LA antibodies should be performed with at least two clotting tests looking at different coagulation reactions.