title: Accuracy of FVIII: C assay by one-stage method can be improved using hemophilic plasma as diluent.
abstract: BACKGROUND
  the basic prerequisite of Factor VIII clotting assay (FVIII:C) by One-Stage Method is that all other than FVIII clotting factors are present in constant concentration in each dilution of both standard reference and patient's plasma curves. On the contrary, the plasma content of each dilution is decreasing as the dilution factor increases.
  
  
  OBJECTIVE
  to keep exactly constant the plasma content in each mixture, we performed all dilutions of both standard reference and patient's plasma with FVIII deficient plasma and further with a fixed amount of buffer (method B). To show the discrepancies between this method and regular method A, using buffer to make dilutions, a comparative study was conducted on FVIII: C assay on samples at known FVIII concentration and in patients' plasma. Imidazole or Owren's buffers and five different aPTT reagents were employed, both in method A and B.
  
  
  RESULTS
  a discrepancy between FVIII: C assays obtained by method A and B was observed, mainly when Pathrontin SL and Imidazole buffer were used. The assays derived from method B always better fit with the expected, calculated, values of FVIII:C concentrations. Furthermore, FVIII: C was assayed in 60 patients: the outcome of method A was always higher than values of method B. The discrepancy between the two methods was higher at FVIII concentrations below 50 U/dL but null at 100 U/dL. The A slope was steeper than B slope and the difference was statistically significant starting from the 1/10 dilution. Accordingly, FVIII: C of patients' plasma obtained by method A was always higher that those obtained by method B, even 2 or 3 times for FVIII level < or = 10 U/dL or 1.4-1.6 times for FVIII levels between 10 and 25 U/dL.
  
  
  CONCLUSIONS
  only method B is able to give FVIII: C assays in agreement with the expected values. The dilution of reference standards and samples with FVIII deficient plasma is crucial to accurately evaluate the post-infusion FVIII concentrations in pharmacokinetic studies or the trough level during prophylactic therapy and to investigate the discrepancy among different FVIII: C assays. In addition, the assessment of severity and classification of hemophilia should be reviewed.
authors.affiliation: Agency for Hemophilia and Regional Reference Center for Inherited Bleeding Disorders, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Cinotti
authors.forename: E
authors.initials: E
authors.lastname: Paladino
authors.forename: M
authors.initials: M
authors.lastname: Morfini
mesh_terms: D001777:Blood Coagulation; D001780:Blood Coagulation Tests / Q000295:instrumentation / Q000379:methods*; D002021:Buffers; D002138:Calibration; D002624:Chemistry, Clinical; D005167:Factor VII / Q000032:analysis*; D006467:Hemophilia A / Q000097:blood; D006801:Humans; D007093:Imidazoles / Q000494:pharmacology; D010949:Plasma / Q000378:metabolism; D012015:Reference Standards; D015203:Reproducibility of Results; D016896:Treatment Outcome; D014842:von Willebrand Diseases / Q000097:blood
chemical_list: D002021:Buffers; D007093:Imidazoles; C029899:imidazole; D005167:Factor VII