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Semin Thromb Hemost 2013; 39(03): 272-282
DOI: 10.1055/s-0033-1334863
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Diagnostic Testing for Mild Hemophilia A in Patients with Discrepant One-Stage, Two-Stage, and Chromogenic Factor VIII:C Assays[*]

Elizabeth M. Duncan
1   Haematology Division, IMVS Pathology, Adelaide, South Australia, Australia
,
Susan E. Rodgers
1   Haematology Division, IMVS Pathology, Adelaide, South Australia, Australia
,
Simon J. McRae
1   Haematology Division, IMVS Pathology, Adelaide, South Australia, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
04 March 2013 (online)

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Abstract

In recent years, there has been greater awareness among hemostasis scientists and clinicians that factor VIII coagulant activity (FVIII:C) measured in certain patients with mild hemophilia A can show different results depending on the assay system. A subgroup of mild hemophilia families have a method-related discrepancy in FVIII:C results, whereby the one-stage clotting assay (FVIII:C-1) is significantly higher than the two-stage clotting assay (FVIII:C-2) or the chromogenic assay (FVIII:C-chr). To identify such patients, the routine laboratory can use automated procedures for the FVIII:C-chr to replace the complex, manual FVIII:C-2 method. Laboratories must employ appropriate quality management to ensure accurate and precise results, especially in the abnormal range. This discrepant phenotype of hemophilia A is seen in up to 40% of mild hemophilia A cases and represents a clinically significant bleeding disorder. A small proportion of these cases have FVIII:C-1 within the normal range and risk a missed diagnosis if the FVIII:C-chr is unavailable. Other patients may be mismanaged if FVIII:C-1 gives an overestimate of FVIII:C and their bleeding risk is consequently underestimated. Affected family members in the discrepant group of patients have a limited range of FVIII (F8) gene missense mutations, causing alterations of the structure of the A1, A2, or A3 domains of FVIII. Therefore, both FVIII:C-chr and F8 gene mutation analysis are recommended to confirm the diagnosis of mild hemophilia A and assist with decisions about the patient's phenotype.

Keywords

factor VIII - hemophilia A - discrepant - assay methods

* Dedicated to the memory of Associate Professor John Viner Lloyd


 

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