%0 Journal Article
%T Screening of the protein C pathway abnormality-related thrombophilia by using thrombomodulin-mediated tissue factor-triggered clot waveform analysis.
%A Hashimoto N
%A Ogiwara K
%A Shimonishi N
%A Nakagawa T
%A Nakajima Y
%A Furukawa S
%A Takeyama M
%A Nogami K
%A Hashimoto N
%A Ogiwara K
%A Shimonishi N
%A Nakagawa T
%A Nakajima Y
%A Furukawa S
%A Takeyama M
%A Nogami K
%A Hashimoto N
%A Ogiwara K
%A Shimonishi N
%A Nakagawa T
%A Nakajima Y
%A Furukawa S
%A Takeyama M
%A Nogami K
%J Eur J Haematol
%V 109
%N 1
%D Jul 2022
%M 35430749
%F 3.674
%R 10.1111/ejh.13777
%X <B>OBJECTIVE: </B>Absolute or relative protein (P)C pathway abnormalities (PC deficiency, PS deficiency, antiphospholipid syndrome (APS), factor (F)V-abnormality, and high FVIII level) cause thrombophilia. Although screening assays for these thrombophilias are available, one utilizing clot waveform analysis (CWA) remains unknown. We aimed to establish a CWA-based screening assay to distinguish PC pathway abnormality-related thrombophilia.<BR><B>METHODS: </B>Samples were reacted with tissue factor (TF)/phospholipids and recombinant thrombomodulin (rTM; optimal 20 nM), followed by CWA measurement. The peak ratio (with/without rTM) of the first derivative curve of clot waveform was calculated.<BR><B>RESULTS: </B>The peak ratio in healthy plasmas (n = 35) was 0.36 ± 0.13; hence, the cutoff value was set to 0.49. The peak ratios in plasmas with PC deficiency, PS deficiency, high-FVIII (spiked 300 IU/dl), and APS were higher than the cutoff values (0.79/0.97/0.50/0.93, respectively). PC-deficient plasma or PS-deficient plasma mixed with normal plasma (25%/50%/75%/100% PC or PS level) showed dose-dependent decreases in the peak ratios (PC deficient: 0.85/0.64/0.44/0.28; PS deficient: 0.69/0.53/0.40/0.25), suggesting that the peak ratio at ≤50% of PC or PS level exceeded the cutoff value. The peak ratio in FV deficiency with FV ≤25% was higher than the cutoff value. FV-deficient plasma spiked with 40 IU/dl rFV-R506Q (FVLeiden ) or rFV-W1920R (FVNara ) showed >90% peak ratios.<BR><B>CONCLUSIONS: </B>rTM-mediated TF-triggered CWA might be useful for screening PC pathway abnormality-related thrombophilia.