Assay of Factor VIII Antibodies by ELISA Using Plasma Specimens Dried On Filter Paper and Stored at Room Temperature.

ELISA assays have been proposed as a complement to the Bethesda assay for detection and follow-up of factor VIII (FVIII) antibodies in subjects with hemophilia. The Bethesda assay has several drawbacks. Most importantly, the Bethesda assay would not detect non-inhibitory antibodies, even though these could be responsible for low in vivo recovery of FVIII and /or a pharmacokinetic pattern suggestive of rapid clearance of FVIII. ELISA assays for detecting antibodies to FVIII are not routinely performed in most hospital laboratories and as such, specimens need to be transported to specialized laboratories for processing. Transportation of plasma specimens frozen on dry ice, however, is both costly and cumbersome. Room temperature storage of whole blood and serum specimens adsorbed and dried onto filter paper has been shown to be a convenient and reliable alternative to frozen whole blood and serum samples for various analyses. This study was undertaken to assess whether FVIII antibodies from haemophilic plasma would display similar stability when stored adsorbed onto filter paper at room temperature for 1 month or on plasma specimens stored frozen. Stability was assessed by comparing results of ELISA assays.

two hundred and thirteen frozen (at -80°C) plasma samples from patients with or without known FVIII inhibitors were tested. Samples came from 97 congenital haemophilic subjects and 5 subjects with acquired haemophilia. The samples were tested with a previously reported ELISA assay (Haemophilia 2009; 15: 374-6) with minor modifications. The coating antigens were two therapeutic preparations of recombinant FVIII: the full length FVIII preparation Helixate^® FS, and the B-domain deleted FVIII Xyntha^®. Five dilutions of plasma from a subject with congenital severe hemophilia A known to have a high Bethesda titer was put on all plates as positive control. Six normal plasmas were used on all plates as negative controls. Mean and standard deviation of optical densities were calculated for negative controls. Mean was subtracted from optical density of each test plasma. The resulting value was divided by the value of one standard deviation of negative controls to generate the number of standard deviations for test plasmas. All plasmas were assayed in duplicate. The numbers of standard deviations were compared between frozen samples and samples dried on filter papers.

The correlation between the numbers of standard deviations obtained with frozen specimens and with specimens dried on filter paper was excellent for both therapeutic preparations of recombinant FVIII, going from R= 0.91 to R= 0.99.

FVIII antibodies tested by ELISA using plasma dried on filter paper for one month at room temperature or plasma stored at -80°C give comparable results.

No relevant conflicts of interest to declare.