title: Measurement of factor XIII (FXIII) activity by an automatic ammonia release assay using iodoacetamide blank-procedure: no more overestimation in the low activity range and better detection of severe FXIII deficiencies.
abstract: BACKGROUND
  Laboratory investigation with specific factor XIII (FXIII) assays plays a crucial role in diagnosis of FXIII deficiency. According to the International Society on Thrombosis and Hemostasis (ISTH), it is necessary a blank sample with iodoacetamide, provided by the kit or locally prepared, when the ammonia release assays are used, to avoid FXIII activity overestimation.
  
  
  METHODS
  In this study we set up a modification of the Berichrom FXIII chromogenic assay, in which iodoacetamide was added by the BCS analyzer in the reaction mixture of the blank sample, without modifications of the original reagents. We analyzed 100 plasma samples of outpatients with clinical symptoms suggestive of a bleeding diathesis (20 samples had FXIII activity <20%).
  
  
  RESULTS
  In all samples blank subtraction significantly reduced FXIII activity, mostly in the low activity range group (from 10.1% to 2.4%, p<0.0001). In this group correction with iodoacetamide also increased the agreement with the immunoassay and allowed FXIII activity measure up to 0%.
  
  
  CONCLUSIONS
  Despite the low number of samples included in the study, the described automatic procedure seemed to decrease FXIII activity overestimation and, especially for low activity range samples (<20%), to improve the agreement between FXIII activity and concentration. Our data suggested that iodoacetamide correction could allow the detection of severe FXIII deficiencies (activity <5%) otherwise undiagnosed using the original method.
authors.forename: Michela
authors.initials: M
authors.lastname: Cini
authors.forename: Cristina
authors.initials: C
authors.lastname: Legnani
authors.forename: Mirella
authors.initials: M
authors.lastname: Frascaro
authors.forename: Claudia
authors.initials: C
authors.lastname: Pancani
authors.forename: Costanza
authors.initials: C
authors.lastname: Cappelli
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Rodorigo
authors.forename: Lelia
authors.initials: L
authors.lastname: Valdrè
authors.forename: Benilde
authors.initials: B
authors.lastname: Cosmi
mesh_terms: D000328:Adult; D000641:Ammonia / Q000737:chemistry*; D001331:Automation; D001774:Blood Chemical Analysis; D005176:Factor XIII / Q000032:analysis* / Q000378:metabolism; D005177:Factor XIII Deficiency / Q000097:blood / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007460:Iodoacetamide / Q000737:chemistry*; D008297:Male
chemical_list: D000641:Ammonia; D005176:Factor XIII; D007460:Iodoacetamide