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Sally Mandour: The Paradox of Lupus Anticoagulant
Sally Mandour/LinkedIn
Oct 26, 2026, 15:37

Sally Mandour: The Paradox of Lupus Anticoagulant

Sally Mandour, Associate Professor, Head of Hematology Unit at Clinical Pathology Department of National Liver Institute, Monofeya University, shared a post on LinkedIn:

“Lupus Anticoagulant Understanding

‘A positive test for a negative name’.

One of the most counterintuitive concepts in coagulation:

a ‘lupus anticoagulant‘ doesn’t cause bleeding in vivo – it’s associated with thrombosis.

The name comes purely from its behaviour in vitro, where it prolongs phospholipid-dependent clotting tests.

The ISTH minimum diagnostic criteria require proving three conditions:

  1.  An abnormality in phospholipid-dependent coagulation (a prolonged APTT or PT).
  2.  That the abnormality is caused by an inhibitor, not a factor deficiency.
  3.  That the inhibitor is phospholipid-dependent, not a specific factor inhibitor.

How each criterion gets tested:

  •  Criterion 1 – A phospholipid-based clotting assay (APTT, PT, dRVVT, KCT, or PTT-LA)
  •  Criterion 2 – A 1:1 mixing study with normal plasma. If the clotting time corrects then factor deficiency. If it stays prolonged then an inhibitor is present. (A second tube is incubated 1–2 hours to also exclude a specific-factor inhibitor.)
  • Criterion 3 – Repeating the test with varying phospholipid concentrations. If adding more phospholipid shortens the clotting time, the inhibitor is phospholipid-directed – consistent with LA.

In comments the 3 ratios explained.”

Sally Mandour: The Paradox of Lupus Anticoagulant

Other posts featuring Sally Mandour on Hemostatis Today.

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