Current practices for lupus anticoagulant testing at a tertiary care hospital and impact on laboratory resources

BACKGROUND AND OBJECTIVES: The lupus anticoagulant (LA) test is an advanced test that is time consuming and requires a highly trained lab specialist. A high proportion of clinicians do not adhere to international guidelines and request the test inappropriately. DESIGN AND SETTINGS: This descriptive study covered the period from January 2012 and January 2013 at the Hematology Laboratory at King Khalid University Hospital, Riyadh. PATIENTS AND METHODS: The 274 lupus anticoagulant requests were categorized as proper or improper based on the guidelines of the International Society of Thrombosis and Haemostasis (ISTH). Data on numbers of requests and cost are summarized. RESULTS: Of the 274 requests, 222 (81%) were classified as proper while 52 (19%) requests did not satisfy ISTH guidelines. The most frequently encountered incorrect indications were warfarin therapy (46%), heparin therapy (27%), a normal aPTT with no clinical indication (25%) and low serum fibrinogen levels (2%). The total cost of all improper requests was about 41 080 SAR (10 954 USD). CONCLUSION: A majority of improper requests were related to anticoagulant therapy, which highlights the importance of implementing a comprehensive diagnostic algorithm for patients on warfarin and heparin therapy.