PB1066 - Discrimination between acquired hemophilia A and lupus anticoagulant using global coagulation assays

Tuesday, July 12, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Yushi Chikasawa, Assistant Professor

Assistant Professor
Department of Laboratory Medicine, Tokyo Medical University,Ｊapan
Tokyo, Tokyo, Japan

Co-Author(s)

KA

Kagehiro Amano

Professor
Department of Laboratory Medicine, Tokyo Medical University
Tokyo, Tokyo, Japan
KS

Keiko Shinozawa

Assistant Professor
Department of Laboratory Medicine, Tokyo Medical University
Shinjuku-ku, Tokyo, Japan
YH

Yuko Harada

Staff Physician
Tokyo Medical University
Shinjukuku, Tokyo, Japan
AM

Ayano Mitsuhashi

Researcher
Department of Laboratory Medicine, Tokyo Medical University
Tokyo, Tokyo, Japan
RM

Ryui Miyashita

Staff Physician
Tokyo Medical University
Shinjukuku, Tokyo, Japan
Tomoko Yamaguchi, MD

Staff physician
Tokyo Medical University
Shinjukuku, Tokyo, Japan
YK

Yoshiko Kamikubo

Staff Physician
Tokyo Medical University
Shinjukuku, Tokyo, Japan
AI

Akito Ichiki

Staff Physician
Tokyo Medical University
Shinjukuku, Tokyo, Japan
MB

Masato Bingo

Assistant Professor
Department of Laboratory Medicine, Tokyo Medical University
Shinjuku-ku, Tokyo, Japan
RS

Ryoko Sekiya

Staff Physician
Tokyo Medical University
Shinjukuku, Tokyo, Japan
TM

Takashi Muramatsu

associate professor/lecturer
Tokyo Medical University
Shinjukuku, Tokyo, Japan
MY

Mihoko Yotsumoto

associate professor/lecturer
Tokyo Medical University
Shinjukuku Nishishinjuku, Tokyo, Japan
TH

Takeshi Hagiwara

Associate Professor
Department of Laboratory Medicine, Tokyo Medical University
Shinjuku-ku, Tokyo, Japan
HI

Hiroshi Inaba

Assistant Professor
Department of Laboratory Medicine, Tokyo Medical University
Shinjuku-ku, Tokyo, Japan
EK

Ei Kinai

Professor
Department of Laboratory Medicine, Tokyo Medical University
Shinjuku-ku, Tokyo, Japan

Background: Acquired hemophilia A (AHA) and lupus anticoagulant (LA) have opposing phenotypes of bleeding or thrombotic tendency. However, both can cause acquired activated partial thromboplastin time (aPTT) prolongation and show a non-coagulation factor deficiency pattern in a cross-mixing test.

Aims: To compare the usefulness of rotational thromboelastometry (ROTEM) with that of thrombin generation assay (TGA) and clot waveform analysis (CWA) in distinguishing AHA from LA.

Methods: Patients diagnosed with AHA or LA in Tokyo Medical University Hospital from November 2019 to September 2021 underwent ROTEM (NATEM, INTEM, EXTEM), TGA triggered by tissue factor, and CWA using Thrombocheck APTT-SLA (Sysmex Corporation, Kobe, Japan). LA was defined as either a non-coagulation factor deficiency pattern in the cross-mixing test with an index of circulation anticoagulant (ICA) of >12.4 using Thrombocheck APTT-SLA or a positive phospholipid neutralization assay using the aPTT or dilute Russell viper venom time. The Mann–Whitney U test was used for statistical analysis.

Results: Ten of 10 patients with AHA and 16 of 32 patients with LA showed an ICA of >12.4. The median aPTT in AHA vs. LA was 86.8 (interquartile range: 71.6–98.4) vs. 42.9 (37.4–49.4) seconds (p < 0.001). With ROTEM, the median clotting time of NATEM mode in AHA vs. LA was 3,600 (2,768.5–3,600) vs. 553 (452–624) seconds (p < 0.001). With TGA, the median peak thrombin in AHA vs. LA was 16.1 (13.6–25.7) vs. 173.8 (130.8–252.7) nM (p < 0.001). With CWA, the median |min1| (maximum velocity) in AHA vs. LA was 2.10 (1.69–3.14) vs. 6.73 (5.81–8.37) (p < 0.001). As shown in the figure, any test may be useful; in this study, however, only the clotting time of ROTEM in NATEM mode and peak thrombin of TGA completely distinguished between the two groups.

Conclusion(s): ROTEM in NATEM mode can clearly distinguish between AHA and LA.