title: Detection of the factor VLeiden mutation. Development of a testing algorithm combining a coagulation assay and molecular diagnosis.
abstract: The Coagulation and Molecular Diagnostic laboratories at the University of Minnesota Medical School (Minneapolis) have collaborated to develop a diagnostic algorithm to identify all factor VLeiden mutation carriers without performing unnecessary and expensive genetic testing. The algorithm uses a coagulation assay for activated protein C resistance (APCR) to determine the need for genetic testing. We report the results of our experience validating this program. We compared the sensitivity, specificity, and positive and negative predictive values of two measures of APCR, the APCR ratio and the normalized ratio. We found that the normalized ratio was the more sensitive but less specific parameter to determine the need for genetic testing. By using the normalized ratio as the standard by which to refer patients to the Molecular Diagnostics Laboratory, all mutation carriers were identified. We found a large overlap in both measures of APCR between symptomatic patients with normal genotype and mutation carriers. Furthermore, we demonstrated that increased factor VIII levels with a normal genotype are associated with apparent APCR. In this article we also review other correlates of apparent APCR.
authors.affiliation: Department of Medicine, University of California, San Diego, La Jolla 92093-0639, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Wasserman
authors.forename: J R
authors.initials: JR
authors.lastname: Edson
authors.forename: N S
authors.initials: NS
authors.lastname: Key
authors.forename: R
authors.initials: R
authors.lastname: Chibbar
authors.forename: R C
authors.initials: RC
authors.lastname: McGlennen
mesh_terms: D000328:Adult; D000465:Algorithms; D001780:Blood Coagulation Tests / Q000379:methods*; D004247:DNA; D005165:Factor V / Q000235:genetics*; D005169:Factor VIII / Q000032:analysis; D005260:Female; D006801:Humans; D008297:Male; D009154:Mutation; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D011486:Protein C / Q000378:metabolism*; D012016:Reference Values; D012680:Sensitivity and Specificity
chemical_list: D011486:Protein C; C095381:factor V Leiden; D005165:Factor V; D005169:Factor VIII; D004247:DNA