What is the consequence of the APTT test in the presence of lupus anticoagulant?

The APTT (Activated Partial Thromboplastin Time) test is a critical assessment used to evaluate the intrinsic and common pathways of coagulation. In the presence of lupus anticoagulant, a type of antiphospholipid antibody, the APTT test demonstrates a distinct behavior: it remains prolonged regardless of mixing with normal plasma.

Lupus anticoagulants can inhibit the phospholipid-dependent clotting factors, leading to a prolonged APTT. When normal plasma is mixed with the plasma of a patient who has lupus anticoagulant, the prolongation does not resolve, as it typically would if the prolongation were due to a factor deficiency rather than an inhibitor. This characteristic distinguishes the presence of lupus anticoagulant from other causes of APTT prolongation, like factor deficiencies, where mixing would normalize the test.

The persistence of a prolonged APTT in this situation indicates an inhibitory effect of the lupus anticoagulant rather than just a deficiency of coagulation factors. This understanding is important in the context of diagnosing and monitoring patients with antiphospholipid syndrome and similar conditions.