title: Whole blood rotation thromboelastometry (ROTEM(®)) in nine severe factor V deficient patients and evaluation of the role of intraplatelets factor V.
abstract: Severe factor V (FV) deficiency (parahaemophilia) is a rare congenital hemorrhagic disorder characterized by very low or undetectable plasma FV levels and bleeding phenotype ranging from mild to severe. We evaluated whole blood (WB) rotation thromboelastometry (ROTEM) in parahaemophilia patients and the contribution of intraplatelets FV, if any, to clot formation. Standard ROTEM(®) assays were performed in WB from nine parahaemophilia patients and 50 healthy controls. In addition, platelets poor plasma from one parahaemophilia patient (PPP-Pt) or normal subjects (PPP-N) was reconstituted with washed platelets obtained either from one patient with parahaemophilia (Plts-Pt) or normal subjects (Plts-N) and ROTEM assays were performed in platelets rich plasma (PRP) samples. There was a prolongation of the WB clotting time (CT) in all assays in patients as compared with controls. However, maximum clot firmness (MCF) was similar in patients and controls. ROTEM in PPP-Pt showed both a prolongation of CT and a reduction of MCF as compared with PPP-N. The addition of either Plts-Pt or Plts-N to PPP-Pt resulted in similar increase in MCF and a decrease of CT which was more evident for PPP-Pt + Plts-N than PPP-Pt + Plts-Pt. In contrast, the addition of Plts-Pt or Plts-N to PPP-N had superimposable effects on both CT and MCF. In parahaemophilia patients, WB ROTEM(®) presents mainly with prolongation of CT and no relevant effect on MCF. Residual intraplatelets FV in parahaemophilia contributes significantly to thrombin generation as shown in artificially reconstituted PRP models.
authors.affiliation: Department of Cardiologic, Thoracic, and Vascular Sciences, 2nd Chair of Internal Medicine, University of Padua Medical School, Padua, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Spiezia
authors.forename: C
authors.initials: C
authors.lastname: Radu
authors.forename: E
authors.initials: E
authors.lastname: Campello
authors.forename: C
authors.initials: C
authors.lastname: Bulato
authors.forename: D
authors.initials: D
authors.lastname: Bertini
authors.forename: G
authors.initials: G
authors.lastname: Barillari
authors.forename: V
authors.initials: V
authors.lastname: De Angelis
authors.forename: P
authors.initials: P
authors.lastname: Pradella
authors.forename: E
authors.initials: E
authors.lastname: Zanon
authors.forename: P
authors.initials: P
authors.lastname: Simioni
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001777:Blood Coagulation / Q000502:physiology*; D001779:Blood Coagulation Factors / Q000502:physiology*; D005166:Factor V Deficiency / Q000097:blood* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013916:Thrombelastography / Q000379:methods*
chemical_list: D001779:Blood Coagulation Factors; C037685:platelet factor V