title: Heparin neutralization is essential for accurate measurement of factor VIII activity and inhibitor assays in blood samples drawn from implanted venous access devices.
abstract: The purpose of this study was to determine the prevalence and effect of heparin contamination in samples drawn from implanted venous access devices (VADs, ports) on factor VIII activity and Bethesda inhibitor assay (BU) and the efficacy of heparinase to neutralize heparin. Plasma samples containing 85, 45, and 2 U/dL factor VIII were spiked in vitro with heparin from 0 to 3 U/mL. Factor VIII activity was assayed with a one-stage clotting assay on paired samples before and after heparinase, 25 mg/mL plasma. Paired patient samples drawn from VADs were assayed for heparin concentration, factor VIII, and BU before and after heparinase. At all three concentrations of factor VIII in vitro, the addition of heparin at 0.12 to 0.25 U/mL decreased assayed factor VIII activity. Heparinase neutralized up to 2 U/mL heparin and resulted in accurate factor VIII determination. Of 105 VAD samples, 47 (45%) had heparin contamination >0.05 U/mL. Of 47 heparin-contaminated samples, 42 showed decreased factor VIII activity in before/after comparisons. False-positive BU results were detected in 6 of 47 heparin-contaminated samples. Heparin contamination occurs frequently in samples drawn from VADs and could increase costs through excessive factor concentrate use. We recommend that all VAD samples be pretreated with heparinase before the assay of factor VIII activity or Bethesda inhibitor titers.
authors.affiliation: Mountain States Regional Hemostasis and Thrombosis Center and the Department of Pediatrics, University of Colorado Health Sciences Center, Aurora 80045-0507, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Manco-Johnson
authors.forename: R
authors.initials: R
authors.lastname: Nuss
authors.forename: L J
authors.initials: LJ
authors.lastname: Jacobson
mesh_terms: D000906:Antibodies / Q000032:analysis; D001800:Blood Specimen Collection / Q000379:methods*; D002408:Catheters, Indwelling; D002675:Child, Preschool; D005169:Factor VIII / Q000032:analysis* / Q000037:antagonists & inhibitors; D005188:False Negative Reactions; D006467:Hemophilia A / Q000097:blood*; D006493:Heparin / Q000097:blood*; D019763:Heparin Lyase; D006801:Humans; D007223:Infant; D011786:Quality Control; D015203:Reproducibility of Results; D014680:Veins
chemical_list: D000906:Antibodies; D005169:Factor VIII; D006493:Heparin; D019763:Heparin Lyase