Problems in the detection of carriers of hemophilia A: the influence of stress and thrombin.

After exposure to stress, factor VIII coagulant activity and factor VIII antigen were determined in healthy volunteers for about 3 days. Three out of four volunteers at different time showed results resembling a carrier state. In vitro incubation of plasma with thrombin in decreasing concentrations showed increased factor VIII coagulant activity, although no fibrin clot or fibrin monomers were formed. The concentration of factor VIII antigen remained constant. The action of thrombin can explain the misclassification of known carriers.