Hexagonal Phase Neutralization

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The page below is a sample from the LabCE course Laboratory Evaluation of the Lupus Anticoagulant found in Antiphospholipid Syndrome (APS). Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

Learn more about Laboratory Evaluation of the Lupus Anticoagulant found in Antiphospholipid Syndrome (APS) (online CE course)
Hexagonal Phase Neutralization

Many of the LA recognize the hexagonal phase phospholipid configuration as an antigenic epitope and will be neutralized in contrast to factor-specific antibodies, which are not neutralized. The test is a two-part test:
  1. An aPTT-based assay is performed using an LA-sensitive reagent with and without the phospholipid source of hexagonal phase phosphatidyl-ethanolamine (HPE). The HPE neutralizes the LA in the patient's plasma, which results in a shortened time.
  2. An aPTT-based clotting time without the addition of the HPE. The result is considered positive when there is a difference of >8 seconds.
This test also includes the addition of normal plasma to correct for any prolongation of a clotting time due to a factor deficiency, increasing the test's specificity. The test includes a heparin neutralizer which makes the test insensitive to heparin levels up to 1 IU/mL. Direct thrombin inhibitors and FVIII inhibitors can cause false positives in this test.