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Haisma B, Schols SEM, van Oerle RGM, Verbeek-Knobbe K, Hellenbrand D, Verwoerd EJ, Heubel-Moenen FCJI, Stroobants AK, Meijer D, Rijpma SR, Henskens YMC. Comparative analysis of thrombin generation platforms for patients with coagulation factor deficiencies: A comprehensive assessment. Thromb Res 2024; 240:109045. [PMID: 38834002 DOI: 10.1016/j.thromres.2024.109045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/13/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
INTRODUCTION Thrombin generation assays (TGAs) assess the overall functionality of the hemostatic system and thereby provide a reflection of the hemostatic capacity of patients with disorders in this system. Currently, four (semi-)automated TGA platforms are available: the Calibrated Automated Thrombogram, Nijmegen Hemostasis Assay, ST Genesia and Ceveron s100. In this study, we compared their performance for detecting patients with congenital single coagulation factor deficiencies. MATERIALS AND METHODS Pooled patient samples, healthy control samples and normal pooled plasma were tested on all four platforms, using the available reagents that vary in tissue factor and phospholipid concentrations. The TGA parameters selected for analysis were peak height and thrombin potential. Results were normalized by using the calculated mean of healthy controls and a correction for between-run variation. Outcomes were presented as relative values, with the mean of healthy controls standardized to 100 %. RESULTS Across all platforms and reagents used, thrombin potentials and peak heights of samples with coagulation factor deficiencies were lower than those of healthy controls. Reagents designed for bleeding tendencies yielded the lowest values on all platforms (relative median peak height 19-32 %, relative median thrombin potential 19-45 %). Samples representing more severe coagulation factor deficiencies generally exhibited lower relative peak heights and thrombin potentials. CONCLUSIONS Thrombin generation assays prove effective in differentiating single coagulation factor deficient samples from healthy controls, with modest discrepancies observed between the platforms. Reagents designed for assessing bleeding tendencies, featuring the lowest tissue factor and phospholipid concentrations, emerged as the most suitable option for detecting coagulation factor deficiencies.
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Affiliation(s)
- Bauke Haisma
- Department of Hematology, Radboud university medical center, Geert Grooteplein Zuid 10, 5425 GA Nijmegen, the Netherlands; Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Geert Grooteplein Zuid 10, 5425 GA Nijmegen, the Netherlands.
| | - Saskia E M Schols
- Department of Hematology, Radboud university medical center, Geert Grooteplein Zuid 10, 5425 GA Nijmegen, the Netherlands; Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Geert Grooteplein Zuid 10, 5425 GA Nijmegen, the Netherlands.
| | - René G M van Oerle
- Central Diagnostic Laboratory, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands; Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.
| | - Kitty Verbeek-Knobbe
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Geert Grooteplein Zuid 10, 5425 GA Nijmegen, the Netherlands; Department of Laboratory Medicine, Laboratory of Hematology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 5425 GA Nijmegen, the Netherlands.
| | - Dave Hellenbrand
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Geert Grooteplein Zuid 10, 5425 GA Nijmegen, the Netherlands; Central Diagnostic Laboratory, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.
| | - Evelien J Verwoerd
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Geert Grooteplein Zuid 10, 5425 GA Nijmegen, the Netherlands; Department of Laboratory Medicine, Laboratory of Hematology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 5425 GA Nijmegen, the Netherlands.
| | - Floor C J I Heubel-Moenen
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Geert Grooteplein Zuid 10, 5425 GA Nijmegen, the Netherlands; Department of Hematology, Internal Medicine, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.
| | - An K Stroobants
- Department of Laboratory Medicine, Radboudumc Laboratory of Diagnostics, Radboud university medical center, Geert Grooteplein Zuid 10, 5425 GA Nijmegen, the Netherlands.
| | - Danielle Meijer
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Geert Grooteplein Zuid 10, 5425 GA Nijmegen, the Netherlands; Department of Laboratory Medicine, Laboratory of Hematology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 5425 GA Nijmegen, the Netherlands.
| | - Sanna R Rijpma
- Department of Hematology, Radboud university medical center, Geert Grooteplein Zuid 10, 5425 GA Nijmegen, the Netherlands; Department of Laboratory Medicine, Laboratory of Hematology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 5425 GA Nijmegen, the Netherlands.
| | - Yvonne M C Henskens
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Geert Grooteplein Zuid 10, 5425 GA Nijmegen, the Netherlands; Central Diagnostic Laboratory, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands; Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.
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Puetz J, Hu B. Factor activity levels and bleeding scores in pediatric hemophilia carriers enrolled in the ATHNdataset. Pediatr Blood Cancer 2023; 70:e30644. [PMID: 37638815 DOI: 10.1002/pbc.30644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/22/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Multiple studies have now shown that a significant proportion of hemophilia carriers meet the criteria for having hemophilia and/or report abnormal bleeding. However, to date, investigations of hemophilia carriers have almost exclusively involved women over 18 years of age. Little is known about factor activity levels and bleeding scores in carriers during childhood. We queried a large deidentified database of subjects with bleeding disorders residing in the United States to determine factor activity levels and bleeding scores. PROCEDURES The ATHNdataset was queried for hemophilia carriers under 18 years of age. Collected information included demographics, factor activity levels, and bleeding scores. RESULTS Over 700 carriers in the pediatric age group were identified, of which 626 submitted factor activity levels. Nearly half had factor activity levels less than 40 IU/dL, thereby meeting criteria for having hemophilia. Of those reporting bleeding scores, only 13.5% reported an abnormal bleeding score for age. The proportion reporting abnormal bleeding scores was higher in those with factor levels less than 40 IU/dL (23%) than those greater than 40 IU/dL (9.7%). CONCLUSIONS The proportion of pediatric carriers with hemophilia was double of that previously reported for adults. Of those with hemophilia reporting a bleeding score, the majority (77%) did not report an abnormal bleeding score for age. However, nearly 10% of pediatric carriers not meeting criteria for having hemophilia reported abnormal bleeding scores for age. Similar results are reported in adults suggesting that factor activity levels may not be predictive of bleeding symptoms in carriers.
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Affiliation(s)
- John Puetz
- Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri, USA
| | - Brian Hu
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, American Thrombosis and Hemostasis Network, Rochester, New York, USA
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Dhaha Y, El Borgi W, Elmahmoudi H, Achour M, Fekih Salem S, Ben Lakhal F, Meddeb B, Gouider E. Factor XI deficiency: About 20 cases and literature review. LA TUNISIE MEDICALE 2022; 100:60-65. [PMID: 35822334 PMCID: PMC9002864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Factor XI deficiency is a rare coagulation disorder with variable bleeding manifestations. AIM To evaluate the correlation between the degree of factorXI deficiency and the clinical expression of the disease. METHODS Retrospective study, spanning 10 years from January 1, 2010 to December 31, 2019, concerning patients followed at the Hemophilia Center at Aziza Othmana Hospital in Tunis. The data were collected from the medical records. The determination of PT, APTT, fibrinogen level and coagulation factors are performed by coagulometric technique on STA® compact / ACL TOP®. FactorXI deficiency was confirmed on two different samples. Statistical analysis of the clinical-biological correlation was performed using the chi-square test. The significance level was 0.05. RESULTS Twenty patients were collected. The mean age of discovery was 25 years with a sex ratio (M/F) =0.33. The circumstances of discovery were incidental in 14 patients. A family history of bleeding was reported in 30% of cases. Eight patients underwent surgery, six of whom had a simple postoperative course. The APTT was prolonged and isolated in 75% of cases. The hemostasis test was normal in 5 cases. The average FactorXI level was 24%. The tendency to bleed did not seem to be correlated with FactorXI levels. CONCLUSION Prospective multicenter studies including molecular study would be necessary to better elucidate this rare disorder.
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Affiliation(s)
- Yosra Dhaha
- 1- Service d’hématologie biologique CHU Aziza Othmena / Faculté de Médecine de Sousse
| | - Wijdène El Borgi
- 2- Service d’hématologie biologique CHU Aziza Othmena / Faculté de médecine de Tunis
| | - Hajer Elmahmoudi
- 3- Service d’hématologie biologique CHU Aziza Othmena / Faculté des Sciences Tunis
| | - Mariem Achour
- 4- Service d’hématologie clinique. CHU Aziza Othmana. Faculté de médecine de Tunis
| | - Sarra Fekih Salem
- 5- Service d’hématologie biologique. CHU Aziza Othmana. Faculté de Pharmacie de Monastir
| | - Fatma Ben Lakhal
- 2- Service d’hématologie biologique CHU Aziza Othmena / Faculté de médecine de Tunis
| | - Balkis Meddeb
- 4- Service d’hématologie clinique. CHU Aziza Othmana. Faculté de médecine de Tunis
| | - Emna Gouider
- 2- Service d’hématologie biologique CHU Aziza Othmena / Faculté de médecine de Tunis
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