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Pro CR global: an effective screening test for thrombophilia
1Department of Haematoloy, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Insights
The Pro C(R) Global test effectively screens for protein C (PC) and protein S (PS) pathway defects. This test shows high sensitivity for detecting thrombosis-related anticoagulant deficiencies.
Area of Science:
- Hematology
- Clinical Chemistry
- Thrombosis Research
Background:
- The protein C (PC) and protein S (PS) pathway is crucial for anticoagulation.
- Deficiencies or resistance in this pathway are linked to thrombotic events.
- Accurate screening for these deficiencies is vital for patient management.
Purpose of the Study:
- To evaluate the Pro C(R) Global test as a screening tool for PC/PS pathway activity.
- To assess the test's performance against established diagnostic methods for anticoagulant factors.
Main Methods:
- The Pro C(R) Global test was performed on 300 patients with a history of thrombosis.
- Further laboratory tests (PC, PS, APCR, LAC) were conducted on patients with abnormal or normal Pro C(R) Global results.
- Sensitivity, specificity, and diagnostic accuracy were calculated.
Main Results:
- The Pro C(R) Global test was positive in 74 patients, with 66 showing a defect in the PC/PS/APCR or LAC pathway.
- Sensitivity was 97% and specificity was 50%, with a diagnostic accuracy of 88.1%.
- Two patients with PS deficiency tested negative with Pro C(R) Global.
Conclusions:
- The Pro C(R) Global test is a sensitive screening tool for detecting abnormalities in the PC/PS/APCR/LAC pathway.
- It can be effectively used to identify patients requiring further investigation for thrombophilia.
- While highly sensitive, its specificity suggests confirmatory testing is necessary.
Abstract:
In the present study, the Pro C(R) Global test was evaluated as a screening test for estimation of the activity of the main plasma components of the anticoagulant protein C (PC) / protein S (PS) pathway; 300 patients with a history of thrombosis were investigated for Pro C(R) Global. It was positive in 74 patients. Tests for estimation of PC, PS, activated protein C resistance (APCR), and lupus anticoagulant (LAC) were performed in all the patients with abnormal Pro C(R) Global and in 10 patients with normal Pro C(R) Global. In all, 66 of the 74 patients had a defect in PC/PS/APCR or LAC; 18 patients had both PC and PS deficiency, 25 had PS deficiency alone, 10 had PC deficiency alone, one had APCR alone, eight had PS, PC deficiency with APCR, and four had PS deficiency with APCR. In the 10 patients who tested negative with the Pro C(R) Global test, PC, APCR, and LAC were negative in all. However, PS deficiency was seen in two of them. The sensitivity and specificity of Pro C(R) Global, calculated with respect to positivity of PC, PS, LAC, or APCR as the gold standard, were 97% and 50%, respectively. The diagnostic accuracy of the assay was 88.1%. It is thus recommended that Pro C(R) Global can be used effectively as a screening test to detect abnormality in the PC/PS/APCR/LAC pathway.
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