Antiphospholipid Syndrome Evaluation Panel with Reflexes

Test Code

APHOSEVAL

Quest Code

91248

Alias/See Also

ANTIPHOSPHOLIPID SYNDROME EVAL

CPT Codes
86146 (x3), 86147 (x3), 83516 (x2), 85613

Includes

Beta2-Glycoprotein I Antibodies (IgG, IgA, IgM)
Phosphatidylserine/Prothrombin (PS/PT) Antibody (IgG)
Phosphatidylserine/Prothrombin (PS/PT) Antibody (IgM)
Cardiolipin Ab (IgM)
Cardiolipin Ab (IgA)
Cardiolipin Ab (IgG)
dRVVT Screen w/rfl dRVVT Confirm and dRVVT1:1 Mix

Reflex Criteria: If dRVVT Screen is prolonged (> 45 seconds), the dRVVT Confirmation will be performed at an additional charge (CPT code(s): 85597).

If dRVVT Confirm is positive, a dRVVT mixing study (nonorderable code 19791) will be performed at an additional charge (CPT code(s): 85613).

Preferred Specimen

1 mL frozen platelet-poor plasma (x3) collected in separate 3.2% sodium citrate (light blue-top) tubes

Minimum Volume

0.5 mL (x3)

Instructions

Plasma (preferred): Centrifuge light blue-top tube 15 minutes at approx. 1500 x g within 60 minutes of collection. Using a plastic pipette, remove plasma, taking care to avoid the WBC/platelet buffy layer and place into a plastic vial. Centrifuge a second time and transfer platelet-poor plasma into a new plastic vial. Plasma must be free of platelets (<10,000/mcL).

Transport Container

Plastic vial(s)

Transport Temperature

Frozen

Specimen Stability

Room temperature: Unacceptable
Refrigerated: Unacceptable
Frozen: 28 days

Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)

Hemolysis • Grossly lipemic

Methodology
Immunoassay (IA) • Clot Detection

Setup Schedule

Set up and Report available: See individual assays

Reference Range

See Laboratory Report

Clinical Significance

The antiphospholipid antibody syndrome (APS) is a clinical-pathologic correlation that includes a clinical event (e.g. arterial or venous thrombosis, pregnancy morbidity) and persistent positive antiphospholipid antibodies (IgM, IgG Cardiolipin or b2GPI antibodies greater than the 99th percentile; or a lupus anticoagulant). International consensus guidelines for APS suggest waiting at least 12 weeks before retesting to confirm antibody persistence. The Systemic Lupus International Collaborating Clinics immunological classification criteria for systemic lupus erythematosus (SLE) include testing for isotype IgA, which has yet to be incorporated into APS criteria. Low level antiphospholipid antibodies may sometimes be detected in the setting of infection, drug therapy or aging.

Note: Target-specific anticoagulant therapy (anti-Xa medications, direct thrombin inhibitors) may cause false positive results for Lupus anticoagulant testing but do not impact the Cardiolipin, B2GPI and Phosphatidylserine antibody testing.

Performing Laboratory
Quest Diagnostics Nichols Institute
14225 Newbrook Dr
Chantilly, VA 20153

Last Updated: April 1, 2022

The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.