Figure 2.
The Bayes theorem/Fagan nomograms demonstrating the pretest and posttest probabilities of immune-mediated AA diagnosis with positive PNH or 6p CN-LOHMHC test results. (A) The Bayes likelihood ratio (LR) nomogram illustrating the predictive value of PNH clones for the diagnosis of AA. PNH clones are ∽100% specific for the diagnosis of immune-mediated AA, and have a positive likelihood ratio of ∽92 for the diagnosis of immune-mediated AA. The patient’s clinical presentation and various clinical factors including age, congenital defects, medications, and comorbidities can influence the estimated pretest probability of immune-mediated AA diagnosis. Shown are 3 examples of patients with a high (75%), moderate (50%), and low (3%) pretest clinical suspicion of immune-mediated AA. Identifying a PNH clone raises the posttest probability of immune-mediated AA to >98% for moderate and high probability patients, allowing clinicians to confidently and efficiently establish a diagnosis of immune-mediated AA. In the patient with a very low suspicion of AA based on other factors, a PNH clone strongly suggests AA diagnosis, with a 74% posttest probability of immune-mediated AA. (B) The Bayes LR nomogram illustrating the predictive value of acquired 6p CN-LOHMHC for AA. Acquired 6p CN-LOHMHC is ∽100% specific for the diagnosis of immune-mediated AA, and has a positive LR of ∽23 for the diagnosis of immune-mediated AA. Shown are 3 examples of patients with high (75%), moderate (50%), and low (3%) pretest clinical suspicion of immune-mediated AA. Identifying an acquired 6p CN-LOHMHC clone raises the posttest probability of immune-mediated AA to >98% for the high probability and to >95% for the moderate probability patients, allowing clinicians to confidently and efficiently establish AA diagnosis. The patient who was previously not suspected of having AA due to various clinical characteristics now has a posttest probability of ∽41% of an immune-mediated AA diagnosis, which should be further considered in the clinical evaluation of this patient.

The Bayes theorem/Fagan nomograms demonstrating the pretest and posttest probabilities of immune-mediated AA diagnosis with positive PNH or 6p CN-LOHMHC test results. (A) The Bayes likelihood ratio (LR) nomogram illustrating the predictive value of PNH clones for the diagnosis of AA. PNH clones are ∽100% specific for the diagnosis of immune-mediated AA, and have a positive likelihood ratio of ∽92 for the diagnosis of immune-mediated AA. The patient’s clinical presentation and various clinical factors including age, congenital defects, medications, and comorbidities can influence the estimated pretest probability of immune-mediated AA diagnosis. Shown are 3 examples of patients with a high (75%), moderate (50%), and low (3%) pretest clinical suspicion of immune-mediated AA. Identifying a PNH clone raises the posttest probability of immune-mediated AA to >98% for moderate and high probability patients, allowing clinicians to confidently and efficiently establish a diagnosis of immune-mediated AA. In the patient with a very low suspicion of AA based on other factors, a PNH clone strongly suggests AA diagnosis, with a 74% posttest probability of immune-mediated AA. (B) The Bayes LR nomogram illustrating the predictive value of acquired 6p CN-LOHMHC for AA. Acquired 6p CN-LOHMHC is ∽100% specific for the diagnosis of immune-mediated AA, and has a positive LR of ∽23 for the diagnosis of immune-mediated AA. Shown are 3 examples of patients with high (75%), moderate (50%), and low (3%) pretest clinical suspicion of immune-mediated AA. Identifying an acquired 6p CN-LOHMHC clone raises the posttest probability of immune-mediated AA to >98% for the high probability and to >95% for the moderate probability patients, allowing clinicians to confidently and efficiently establish AA diagnosis. The patient who was previously not suspected of having AA due to various clinical characteristics now has a posttest probability of ∽41% of an immune-mediated AA diagnosis, which should be further considered in the clinical evaluation of this patient.

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