Cardiolipin Antibody (ACL) -IgA

Immunity

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No Fasting Required

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These are associated with: Blood clotting disorders, Recurrent miscarriages, Autoimmune diseases, especially systemic lupus erythematosus (SLE)

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Cardiolipin Antibody (ACL) -IgA Test Information Guide

Section 1: Why is it done?
- Test Description: The Cardiolipin Antibody IgA test measures the presence of IgA-type antibodies directed against cardiolipin, a phospholipid component of cell membranes. This test is part of the antiphospholipid syndrome (APS) diagnostic panel and detects autoimmune responses to cardiolipin.
- Primary Indications: Diagnosis of antiphospholipid syndrome (APS), Evaluation of recurrent thrombosis (blood clots), Assessment of recurrent miscarriages or pregnancy complications, Investigation of unexplained arterial or venous thromboembolism, Monitoring patients with systemic lupus erythematosus (SLE) or other autoimmune disorders, Evaluation of prolonged activated partial thromboplastin time (aPTT)
- Typical Timing/Circumstances: Performed when patients present with thrombotic events, recurrent fetal loss, or clinical features suggestive of antiphospholipid syndrome, Ordered as part of initial APS screening or during acute thrombotic episodes, Repeated testing may be done 12 weeks after initial positive result to confirm diagnosis, Used in pregnant women with adverse pregnancy outcomes or established APS
Section 2: Normal Range
- Reference Range: Negative or <1.0 U/mL (varies slightly by laboratory), Borderline: 1.0-1.5 U/mL, Positive: >1.5 U/mL (mild), >3.0 U/mL (moderate to high)
- Units of Measurement: U/mL (Units per milliliter) or GPL U/mL (Glycerophospholipid units per milliliter)
- Result Interpretation: Negative Result: Absence of cardiolipin IgA antibodies; typical in healthy individuals or low likelihood of APS, Borderline Result: Requires clinical correlation and may warrant repeat testing in 12 weeks, Positive Result: Presence of cardiolipin IgA antibodies; consistent with APS or other antiphospholipid-related conditions
- Normal Versus Abnormal: Normal: Negative or minimal antibody levels indicate normal immune function without autoimmune response to cardiolipin, Abnormal: Elevated levels suggest autoimmune activation and increased thrombotic risk; higher titers correlate with increased clinical manifestations
Section 3: Interpretation
- Negative Results: Indicates low probability of antiphospholipid syndrome, Does not rule out APS if clinical suspicion remains high (may test positive for IgG or IgM instead), Single negative result does not exclude future development of antibodies
- Mildly Positive Results (1.5-3.0 U/mL): May indicate early or transient antiphospholipid antibody response, Requires clinical correlation with patient symptoms and other test results, Often recommends repeat testing in 12 weeks for confirmation, Mildly increased thrombotic risk
- Moderately to Highly Positive Results (>3.0 U/mL): Strong evidence of antiphospholipid syndrome, Associated with significantly increased thrombotic risk, Warrants immediate clinical intervention and anticoagulation consideration, Suggests persistent and clinically significant autoimmune state
- Factors Affecting Results: Acute infections can temporarily increase antiphospholipid antibodies, Timing of blood draw during disease flare may show higher titers, Some medications or recent vaccinations may influence results, Persistent antibodies are more clinically significant than transient elevations, Presence of concurrent IgG or IgM antibodies increases diagnostic specificity
- Clinical Significance: Positive IgA cardiolipin antibodies alone have lower predictive value for thrombosis compared to IgG antibodies, IgA positivity in combination with other antiphospholipid antibodies increases diagnostic and clinical significance, Important for diagnosis when combined with clinical criteria (thrombosis or pregnancy complications), Used to satisfy laboratory criteria for APS diagnosis per Sydney classification
Section 4: Associated Organs
- Primary Organ Systems Involved: Vascular system (arteries and veins throughout the body), Blood/hemostatic system, Placenta and reproductive system, Central nervous system, Lungs, Kidneys
- Associated Medical Conditions: Antiphospholipid syndrome (primary or secondary), Systemic lupus erythematosus (SLE), Sjögren's syndrome, Rheumatoid arthritis, Inflammatory bowel disease, Other connective tissue diseases, Thrombotic events (deep vein thrombosis, pulmonary embolism, stroke)
- Diseases and Complications Associated with Abnormal Results: Recurrent thrombotic events (venous and arterial), Recurrent pregnancy loss and obstetric complications, Catastrophic antiphospholipid syndrome (rare but severe), Cerebral venous sinus thrombosis, Pulmonary hypertension, Livedo reticularis, Hemolytic anemia, Thrombocytopenia, Acute kidney injury from renal microinfarction
- Potential Risks and Complications: Increased thrombotic risk requiring anticoagulation therapy, Pregnancy complications including preeclampsia and placental insufficiency, Risk of bleeding if over-anticoagulated, Chronic hypercoagulable state leading to multiple organ dysfunction, Cardiovascular complications including heart valve disease, Neurological manifestations including cognitive dysfunction and migraine
Section 5: Follow-up Tests
- Complementary Antiphospholipid Antibody Testing: Cardiolipin Antibody IgG and IgM, Lupus Anticoagulant (LAC) test, Beta-2 Glycoprotein I (Beta-2 GPI) antibodies, Phosphatidylserine and other phospholipid antibodies
- Coagulation Studies: Activated Partial Thromboplastin Time (aPTT), Prothrombin time (PT/INR), Thrombin time, Complete blood count (CBC) to assess platelet count
- Autoimmune Screening Tests: Antinuclear antibody (ANA), Anti-dsDNA antibodies, Anti-Smith (Anti-Sm) antibodies, Anti-complement antibodies, Rheumatoid factor
- Confirmatory Testing: Repeat cardiolipin antibody IgA testing in 12 weeks for borderline results, Testing when acute infection or stress is ruled out, Serial titers to monitor disease progression or treatment response
- Monitoring Frequency for Ongoing Conditions: Annual or biannual testing for established APS on anticoagulation therapy, More frequent testing during disease flares or thrombotic events, Testing prior to elective surgery or major procedures, Monitoring during pregnancy in APS patients every 2-4 weeks, Post-thrombotic event monitoring to assess treatment response
- Imaging and Other Diagnostic Studies: Doppler ultrasound if thrombosis suspected, CT angiography or ventilation-perfusion scan for pulmonary embolism evaluation, Echocardiography to assess cardiac valve disease, MRI brain if neurological manifestations present
Section 6: Fasting Required?
- Fasting Requirement: NO - Fasting is NOT required for the Cardiolipin Antibody IgA test. This is a serum antibody test that is not affected by food intake.
- Patient Preparation: Patients may eat and drink normally before the test, No special diet modifications necessary, Maintain regular fluid intake to aid blood draw, Come well-hydrated to promote blood flow
- Medications and Supplements: No need to stop anticoagulation therapy (warfarin, apixaban, rivaroxaban, or other anticoagulants) before testing, Continue all regular medications as prescribed, No specific supplements need to be avoided, Inform healthcare provider of all current medications and supplements, especially immunosuppressants or anticoagulants
- Additional Instructions: Schedule blood draw during morning hours when possible (consistency for serial testing), Avoid blood draws during acute infections when possible, as this may transiently elevate results, Wait at least 12 weeks after initial positive test before repeat testing for confirmation, Allow at least 6 weeks between acute thrombotic events and testing for better accuracy, Inform phlebotomist of any recent vaccinations or acute illness
- Sample Collection: Standard venipuncture blood draw, Serum separator tube (SST) typically used, No special handling or transport requirements, Results usually available within 1-3 business days depending on laboratory

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