Investigation to distinguish between pregnancy acquired hemophilia A and lupus anticoagulant?
In some cases of pregnancy there is antibody formation against the clotting factors, paicularly against factor 8. Dilute Russell's viper venom time- -In-vitro diagnostic test is based on the ability of the venom of the Russell's viper to induce thrombosis. -The venom contains some substances (RVV-V and RVV-X) which directly activate factor V and factor X which turns prothrombin into thrombin in the presence of phospholipid and calcium. -This makes the test sensitive to the presence of lupus anticoagulants, because these antibodies interfere with the clot-promoting role of phospholipid in vitro, and their presence results in a prolonged clotting time. NOTE - the dilute Russell's viper venom test and the hexagonal-phase phospholipids test will be Negative in patients with an acquired inhibitor and Positive in patients with lupus anticoagulants.
Factor 8 assay
dRVVT
von Willlebrand Factor assay
aPTT
Bleeding disorder