PB0140 - LUPUS TESTING IN THE ERA OF EVIDENCE AND GUIDANCE - Revelations from the prescribing practices at a tertiary level healthcare facility specialized lab.

Sunday, June 23, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

AG

AJAY GANDHI

Adjunct Faculty - Hemostasis and Thrombosis
BLK Max Superspeciality Hospital
Gurugram, Haryana, India

Co-Author(s)

ND

NITIN DAYAL

Head - Hematopathology
Max Superspecilaity Hospital, Saket
New Delhi, Delhi, India

Background: Antiphospholipid syndrome is one of those disease entities that require both clinical and diagnostic criteria to be labeled so. While a lot of advancement has been made in attaining accuracy in APS diagnosis, there is, still, a long way to go. Diagnostic tests for APS are marred by inadequate, non-uniform and non-standardized test requests despite clear evidence and guidance.

Aims: The primary aim of the study was to analyze the test requests for APS testing received at the specialized hematology lab of a large tertiary care hospital in northern India. The secondary aim was to evaluate the concurrence of different test methods and systems used in APS diagnosis.

Methods: Data on APS test requests was extracted from the HIS and analyzed against the ISTH recommendations pertaining to adequacy (number of tests), types (test methods), efficacy, chronology (order of testing) and follow up (repeat or confirmation). The data was also corroborated with the laboratory test orders.

Results: Of the 837 requests received in about 6 months, only 21.1% test requests were adequate in asking for both LA tests and APLA as per standard recommendations. 78.9% requests were for lupus anticoagulant only, out of which 38.6% were specifically for dRVVT only. Only 11 (13%) requests were for confirming a positive tests after a gap of 12 weeks. , Out of 5 clinical specialties, rheumatologists adhered the most to the guidance.
2.7% cases were positive for LA as well as APLA tests. 1.8% cases were positive for LA by two different methods.

Conclusion(s): Despite established guidance and ample clinical evidence, the prescribers continue to request for selective tests for APS laboratory diagnosis. Moreover, there is a scarce practice of confirming the positive test after 12 weeks. This suggests that not only there is a huge need for awareness creation but also towards strict compliance.