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HelpTest ID 5INHE Factor V Inhibitor Evaluation, Plasma
Advisory Information
This test is for factor V inhibitors only. If the presence or type of inhibitor is unknown, order APROL / Prolonged Clot Time Profile, Plasma first, except for when screening studies are needed for patients with known hemophilia A or B.
Shipping Instructions
Send all vials in the same shipping container.
Necessary Information
If priority specimen, mark request form, give reason, and request a call-back.
Specimen Required
Patient Preparation:
1. Patient must not be receiving Coumadin (warfarin) or heparin therapy
2. Fasting preferred
Specimen Type: Platelet-poor plasma
Collection Container/Tube: Light-blue top (3.2% sodium citrate)
Submission Container/Tube: 3 Plastic vials
Specimen Volume: 3 mL in 3 plastic vials, each containing 1 mL
Collection Instructions:
1. Specimen must be collected prior to factor replacement therapy.
2. For complete instructions, see Coagulation Guidelines for Specimen Handling and Processing in Special Instructions.
3. Centrifuge, transfer all plasma into a plastic vial, and centrifuge plasma again.
4. Aliquot plasma (1-2 mL per aliquot) into 3 separate plastic vials, leaving 0.25 mL in the bottom of centrifuged vial.
5. Freeze plasma immediately (no longer than 4 hours after collection) at -20° C or, ideally, ≤-40° C.
Additional Information:
1. Double-centrifuged specimen is critical for accurate results as platelet contamination may cause spurious results.
2. Each coagulation assay requested should have its own vial.
Useful For
Detection and quantitation of inhibitors against coagulation factor V.
This test is not useful for the detection of a lupus-like circulating anticoagulant inhibitor, a nonspecific circulating anticoagulant, or other inhibitors that are not specific for coagulation factors.
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| 5INHT | FV Inhib Profile Tech Interp | No | Yes |
| FACTV | Coag Factor V Assay, P | Yes | Yes |
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| 5AINH | FV Inhib Profile Prof Interp | No | No |
| 5BETH | FV Bethesda Units, P | No | No |
| F5_IS | Factor V Inhib Scrn | No | No |
Testing Algorithm
Testing begins with coagulation factor V activity assay with dilutions to evaluate assay inhibition; if the factor V activity assay is normal or increased, then a technical interpretation will be provided.
If the factor V activity assay is decreased, then an inhibitor screen will be performed at an additional charge to look for specific factor V inhibition and a professional interpretation will be provided. If specific inhibition is apparent, the titer of the inhibitor will be determined.
Special Instructions
Method Name
Optical Clot-Based
Reporting Name
Factor V Inhib Profile, PSpecimen Type
Plasma Na CitSpecimen Minimum Volume
2 mL in 2 plastic vials, 1 mL each
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Plasma Na Cit | Frozen | 14 days |
Clinical Information
Factor V inhibitors can occur in patients with congenital factor V deficiency after transfusion of fresh frozen plasma, however, they more commonly occur spontaneously in previously healthy older patients who have no underlying diseases. Topical bovine thrombin or fibrin glue, which contain bovine thrombin and factor V, are commonly used in surgery for topical hemostasis and can result in development of anti-bovine thrombin/factor V inhibitors that cross-react with human thrombin and factor V. Other associations include antibiotics, transfusions, and malignancies.
Reference Values
FACTOR V ACTIVITY ASSAY
Adults: 70-165%
Normal, full-term newborn infants may have borderline low or mildly decreased levels (≥30-35%) which reach adult levels within 21 days postnatal.*
Healthy premature infants (30-36 weeks gestation) may have borderline low or mildly decreased levels.*
*See Pediatric Hemostasis References section in Coagulation Guidelines for Specimen Handling and Processing in Special Instructions.
Interpretation
Normally, there is no inhibitor, ie, negative result.
If the screening assays indicate the presence of an inhibitor, it will be quantitated and reported in Bethesda (or equivalent) units.
Clinical Reference
1. Hematology: Basic Principles and Practice. Seventh edition. Edited by R Hoffman, EJ Benz Jr, LE Silberstein, et al. Elsevier, 2018
2. Kasper CK: Treatment of factor VIII inhibitors. Prog Hemost Thromb 1989;9:57-86
3. Laboratory Hematology Practice. Edited by K Kottke-Marchant. Wiley Blackwell Publishing, 2012
Day(s) and Time(s) Performed
Monday through Friday
Analytic Time
1 dayTest Classification
This test has been modified from the manufacturer's instructions. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.CPT Code Information
85390-Factor V Tech Interp
85220-Factor V
85335-Factor inhibitor (if appropriate)
85335-Factor V Bethesda units (if appropriate)
85390-Factor V Professional Interp (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| 5INHE | Factor V Inhib Profile, P | 96458-5 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 5INHT | FV Inhib Profile Tech Interp | 69049-5 |
| FACTV | Coag Factor V Assay, P | 3193-0 |
Forms
If not ordering electronically, complete, print, and send a Coagulation Test Request (T753) with the specimen.