In vitro diagnostics for the medical dermatologist. Part II: Hypercoagulability tests

Abstract

The skin often provides initial clues of hypercoagulability with features such as livedo reticularis, livedo racemosa, retiform purpura, necrosis, and ulcerations. Because these cutaneous manifestations are nonspecific, laboratory testing is often needed to evaluate for underlying causes of hypercoagulability. Importantly, these disorders are reported to be the most common mimicker, resulting in an erroneous diagnosis of pyoderma gangrenosum. Understanding inherent properties of, and indications for, available tests is necessary for appropriate ordering and interpretation of results. Additionally, ordering of these tests in an indiscriminate manner may lead to inaccurate results, complicating the interpretation and approach to management. This second article in this continuing medical education series summarizes information on methodology, test characteristics, and limitations of several in vitro laboratory tests used for the work up of hypercoagulability and vasculopathic disease as it pertains to dermatologic disease.

Keywords: D-dimer; antiphospholipid antibodies; cryofibrinogenemia; cryoglobulinemia; diagnostic testing; factor deficiency; genetic thrombophilia; hereditary thrombophilia; hypercoagulability; medical dermatology; monoclonal gammopathy; multiple myeloma; pyoderma gangrenosum; retiform purpura; thrombogenic vasculopathy; thrombotic vasculopathy; ulcer.