Explanation

Cardiolipin antibodies: what is measured?

Cardiolipin is a fat-like substance (phospholipid) found in cell membranes, including in mitochondria and platelets. This test checks whether there are antibodies against cardiolipin in the blood. These are autoantibodies: antibodies that the body makes against its own tissue by mistake. In some of the people who have them permanently, the blood clots more easily; that combination with thrombosis or pregnancy problems is called antiphospholipid syndrome. This test measures the IgG and IgM classes together; some laboratories also report them separately.

What can it detect?

Support when antiphospholipid syndrome is suspected, a condition in which the blood clots more easily
Possible explanation for thrombosis at a young age, thrombosis that comes back or thrombosis in an unusual place
Possible explanation for repeated miscarriages or other pregnancy problems

Result

What does the result mean?

Positive result

A positive result means that antibodies against cardiolipin were found. That is not yet a diagnosis. According to the Dutch Society for Clinical Chemistry (NVKC), the test is repeated after about 12 weeks to see whether the antibodies are persistent or temporary. If they remain present and there has also been thrombosis or a pregnancy problem, there is reason to consider antiphospholipid syndrome. A one-off slightly positive result is common after an infection, with some medicines and at older age, and then usually means nothing.

Negative result

A negative result means that no antibodies against cardiolipin were found. This does not rule out antiphospholipid syndrome: it involves three tests, and someone can have only lupus anticoagulant or only antibodies against beta-2 glycoprotein I. In people with lupus (SLE), the test is therefore sometimes repeated, according to the Dutch Society for Clinical Chemistry (NVKC), because they may still develop lupus anticoagulant later.

After an abnormal result

After a positive result, the test is repeated after about 12 weeks, according to the Dutch Society for Clinical Chemistry (NVKC), to see whether the antibodies persist. If they do and there has also been thrombosis or a pregnancy problem, the GP refers you to an internist (specialist in internal medicine); there, lupus anticoagulant and antibodies against beta-2 glycoprotein I are also measured. According to the Dutch medical specialists' guideline (FMS), a positive result without thrombosis or a pregnancy problem is no reason to start blood thinners.

Reliability

How reliable is the test?

The result is mainly meaningful after thrombosis or repeated miscarriages. In people without such events, the chance of antiphospholipid syndrome is very small and false-positive results are much more common than the condition itself. According to the Dutch medical specialists' guideline (FMS), the result only counts if it is positive again after about 12 weeks and the amount of antibodies is clearly raised. A single positive result without symptoms or events is no reason for treatment.

What can affect the result?

A temporary positive result is common during or shortly after an infection, with some medicines and at older age; the Dutch Society for Clinical Chemistry (NVKC) therefore advises repeating the test after about 12 weeks.
Only a persistently positive result with a clearly raised amount counts; a slightly raised value measured once says little.
Cardiolipin antibodies are only one of the three tests for antiphospholipid syndrome; the other two are lupus anticoagulant and antibodies against beta-2 glycoprotein I.
Laboratories use different methods and cut-off values; results from different labs cannot simply be compared.

Who it is for

Who is the test useful for?

Useful for

Useful when a doctor has a specific question: thrombosis at a young age or in an unusual place, thrombosis that comes back without a trigger, repeated miscarriages or other pregnancy problems, or a known autoimmune disease such as lupus. In people without such events, the predictive value is low: a positive result then usually does not mean that you have antiphospholipid syndrome, and no treatment follows.

How common is it?

Antiphospholipid syndrome is rare. Cardiolipin antibodies are found much more often than the syndrome occurs: also in healthy people, temporarily after infections and more often at older age. Thrombosis itself is fairly common, but usually has another cause, such as surgery, sitting still for a long time, pregnancy or the pill.

NVKC and the FMS guideline on antithrombotic policy; no Dutch prevalence figure for APS has been verified

Drawbacks and risks

A positive result without thrombosis and without pregnancy problems is common and usually means nothing. This can lead to unnecessary worry about thrombosis and to repeated tests without anything being found.
A negative result does not rule out antiphospholipid syndrome, because lupus anticoagulant and antibodies against beta-2 glycoprotein I are measured separately.

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