Inhibitor Index in the Clot Waveform Analysis-Based Mixing Test Differentiates among Hemophilia A without and with Inhibitors, and Lupus Anticoagulant.
Inhibitor Index in the Clot Waveform Analysis-Based Mixing Test Differentiates among Hemophilia A without and with Inhibitors, and Lupus Anticoagulant.
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基于血块波形分析的混合测试中的抑制剂指数可区分不使用抑制剂和使用抑制剂的 A 型血友病以及狼疮抗凝剂。
DOI：
10.1055/s-0040-1721776
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Nogami K.
中科院分区：
文献类型：
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作者：
Shimonishi N;Ogiwara K;Oda Y;Kawabe T;Emmi M;Shima M;Nogami K.
背景混合试验用于确定后续检测的途径，也可用于狼疮抗凝剂（LA）阳性的调查。“完全纠正”表示凝血因子缺乏，而“未纠正”表示存在包括LA在内的凝血因子抑制剂。“循环抗凝指数”和/或“校正百分比”用于解释混合研究的结果，但它不能准确区分因子抑制剂和LA。目的使用基于凝块波形分析（CWA）的混合试验精确区分血友病A（HA）、HA加抑制剂（HA-inh）和LA。和包括获得的HA的HA-inh与正常血浆以9：1、1：1和1：9的混合比孵育。从活化部分凝血活酶时间CWA在0分钟（立即）和12分钟孵育，CWA参数在12分钟/0分钟（抑制剂指数）的比率进行了assessed.ResultsThe抑制剂指数值的CWA参数使用混合试验在1：1的比例表现出显着差异HA-inh和LA，但不能区分LA从HA-inh完全。用于以9：1和1：9比率进行混合测试的血浆能够完全区分HA-inh（> 0.5BU/mL）和LA。这些指标与抑制物滴度低于40 BU/mL显著相关（r> 0.90），可能通过抑制物指标估计FVIII抑制物滴度。HA和LA中的血浆可以通过在0分钟（立即）以1：1的比例混合来区分。ConclusionThe inhibitor index from CWA based mixing tests with a 12 min incubation could differentiate between HA，HA-inh，and LA quickly.
BackgroundThe mixing test is used to identify the pathway to follow-up testing and is also useful for the investigation of lupus anticoagulant (LA) positivity. “To completely correct” indicates clotting factor deficiency, while “to not correct” indicates the presence of a clotting factor inhibitor including LA. “Index of circulation anticoagulant” and/or “percent correction” is used to interpret the results of mixing studies, but it does not accurately differentiate factor inhibitors from LA.AimTo precisely differentiate hemophilia A (HA), HA with inhibitor (HA-inh), and LA using the clot waveform analysis (CWA)-based mixing test.MethodsPlasma samples from HA, LA, and HA-inh including acquired HA were incubated with normal plasma in 9:1, 1:1, and 1:9 mix ratios. From activated partial thromboplastin time CWA at 0-minute (immediately) and 12-minute incubation, the ratios of CWA parameters at 12 minutes/0 minute (inhibitor index) were assessed.ResultsThe inhibitor index values of CWA parameters obtained using the mixing test in a 1:1 ratio demonstrated a significant difference between HA-inh and LA but could not differentiate LA from HA-inh completely. Plasmas used for the mixing tests in 9:1 and 1:9 ratios were able to fully distinguish between HA-inh (>0.5 BU/mL) and LA. These indices significantly correlated with inhibitor titer below 40 BU/mL (r> 0.90), possibly estimating FVIII inhibitor titer from the inhibitor index. Plasmas in HA and LA could be distinguished by mixing in a 1:1 ratio at 0 minute (immediately).ConclusionThe inhibitor index from CWA-based mixing tests with a 12-minute incubation could differentiate among HA, HA-inh, and LA quickly.