Skip to main content

Testing for Factor V Leiden (FVL) and Prothrombin G20210A Genetic Variants

  • Protocol
  • First Online:
Hemostasis and Thrombosis

Part of the book series: Methods in Molecular Biology ((MIMB,volume 2663))

  • 1382 Accesses

Abstract

Laboratory testing for Factor V Leiden and Prothrombin G20210A genetic variants permits defining the increased relative risk for venous thromboembolism in selected patients. Laboratory DNA testing for these variants may be undertaken by a variety of methods, including fluorescence-based quantitative real-time PCR (qPCR). This is a rapid, simple, robust, and reliable method to identify genotypes of interest. This chapter describes the method that employs PCR amplification of the patient DNA region of interest and genotyping by allele-specific discrimination technology on a quantitative real-time PCR (qPCR) instrument.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Protocol
USD 49.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 219.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 279.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Zhang S, Taylor AK, Huang X, Luo B, Spector EB, Fang P, Richards CS (2018) Venous thromboembolism laboratory testing (factor V Leiden and factor II c.*97G>A), 2018 update: a technical standard of the American College of Medical Genetics and Genomics (ACMG). Genet Med 20(12):1489–1498. https://doi.org/10.1038/s41436-018-0322-z

    Article  PubMed  Google Scholar 

  2. Zöller B, Svensson PJ, Dahlbäck B, Lind-Hallden C, Hallden C, Elf J (2020) Genetic risk factors for venous thromboembolism. Expert Rev Hematol 13(9):971–981. https://doi.org/10.1080/17474086.2020.1804354

    Article  CAS  PubMed  Google Scholar 

  3. Foy P, Moll S (2009) Thrombophilia: 2009 update. Curr Treat Options Cardiovasc Med 11(2):114–128. https://doi.org/10.1007/s11936-009-0012-x

    Article  PubMed  Google Scholar 

  4. Kujovich JL (1993) Prothrombin thrombophilia. In: Adam MP, Mirzaa GM, Pagon RA et al (eds) GeneReviews(®). University of Washington, Seattle copyright © 1993–2022, University of Washington. GeneReviews is a registered trademark of the University of Washington, Seattle. All rights reserved, Seattle

    Google Scholar 

  5. De Stefano V, Martinelli I, Mannucci PM, Paciaroni K, Chiusolo P, Casorelli I, Rossi E, Leone G (1999) The risk of recurrent deep venous thrombosis among heterozygous carriers of both factor V Leiden and the G20210A prothrombin mutation. N Engl J Med 341(11):801–806

    Article  PubMed  Google Scholar 

  6. De Stefano V, Rossi E (2013) Testing for inherited thrombophilia and consequences for antithrombotic prophylaxis in patients with venous thromboembolism and their relatives. Thromb Haemost 110(10):697–705

    Article  PubMed  Google Scholar 

  7. Bertina RM (1997) Factor V Leiden and other coagulation factor mutations affecting thrombotic risk. Clin Chem 43(9):1678–1683

    Article  CAS  PubMed  Google Scholar 

  8. Bertina RM, Koeleman BP, Koster T, Rosendaal FR, Dirven RJ, de Ronde H, van der Velden PA, Reitsma PH (1994) Mutation in blood coagulation factor V associated with resistance to activated protein C. Nature 369(6475):64–67

    Article  CAS  PubMed  Google Scholar 

  9. Sun X, Evatt B, Griffin JH (1994) Blood coagulation factor Va abnormality associated with resistance to activated protein C in venous thrombophilia. Blood 83(11):3120–3125

    Article  CAS  PubMed  Google Scholar 

  10. Voorberg J, Roelse J, Koopman R, Buller H, Berends F, ten Cate JW, Mertens K, van Mourik JA (1994) Association of idiopathic venous thromboembolism with single point-mutation at Arg506 of factor V. Lancet 343(8912):1535–1536

    Article  CAS  PubMed  Google Scholar 

  11. Zoller B, Dahlback B (1994) Linkage between inherited resistance to activated protein C and factor V gene mutation in venous thrombosis. Lancet 343(8912):1536–1538

    Article  CAS  PubMed  Google Scholar 

  12. Zoller B, Svensson PJ, He X, Dahlback B (1994) Identification of the same factor V gene mutation in 47 out of 50 thrombosis-prone families with inherited resistance to activated protein C. J Clin Invest 94(6):2521–2524

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Ruben EA, Rau MJ, Fitzpatrick JAJ, Di Cera E (2021) Cryo-EM structures of human coagulation factors V and Va. Blood 137(22):3137–3144. https://doi.org/10.1182/blood.2021010684

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Kalafatis M, Bertina RM, Rand MD, Mann KG (1995) Characterization of the molecular defect in factor VR506Q. J Biol Chem 270(8):4053–4057

    Article  CAS  PubMed  Google Scholar 

  15. Camire RM, Kalafatis M, Cushman M, Tracy RP, Mann KG, Tracy PB (1995) The mechanism of inactivation of human platelet factor Va from normal and activated protein C-resistant individuals. J Biol Chem 270(35):20794–20800

    Article  CAS  PubMed  Google Scholar 

  16. Shen L, Dahlback B (1994) Factor V and protein S as synergistic cofactors to activated protein C in degradation of factor VIIIa. J Biol Chem 269(29):18735–18738

    Article  CAS  PubMed  Google Scholar 

  17. Dahlback B (1999) Activated protein C resistance and thrombosis: molecular mechanisms of hypercoagulable state due to FVR506Q mutation. Semin Thromb Hemost 25(3):273–289

    Article  CAS  PubMed  Google Scholar 

  18. Dahlback B (2008) Advances in understanding pathogenic mechanisms of thrombophilic disorders. Blood 112(1):19–27

    Article  PubMed  Google Scholar 

  19. Favaloro EJ, Mohammed S, Vong R, Chapman K, Swanepoel P, Kershaw G, Cai N, Just S, Connelly L, Brighton T, Pasalic L (2021) A multi-laboratory assessment of congenital thrombophilia assays performed on the ACL TOP 50 family for harmonisation of thrombophilia testing in a large laboratory network. Clin Chem Lab Med 59(10):1709–1718. https://doi.org/10.1515/cclm-2021-0499

    Article  CAS  PubMed  Google Scholar 

  20. Favaloro EJ, Mirochnik O, McDonald D (1999) Functional activated protein C resistance assays: correlation with factor V DNA analysis is better with RVVT-than APTT-based assays. Br J Biomed Sci 56(1):23–33

    CAS  PubMed  Google Scholar 

  21. Svensson PJ, Zoller B, Dahlback B (1997) Evaluation of original and modified APC-resistance tests in unselected outpatients with clinically suspected thrombosis and in healthy controls. Thromb Haemost 77(2):332–335

    Article  CAS  PubMed  Google Scholar 

  22. Williamson D, Brown K, Luddington R, Baglin C, Baglin T (1998) Factor V Cambridge: a new mutation (Arg306-->Thr) associated with resistance to activated protein C. Blood 91(4):1140–1144

    Article  CAS  PubMed  Google Scholar 

  23. Chan WP, Lee CK, Kwong YL, Lam CK, Liang R (1998) A novel mutation of Arg306 of factor V gene in Hong Kong Chinese. Blood 91(4):1135–1139

    Article  CAS  PubMed  Google Scholar 

  24. Norstrøm E, Thorelli E, Dahlbäck B (2002) Functional characterization of recombinant FV Hong Kong and FV Cambridge. Blood 100(2):524–530. https://doi.org/10.1182/blood-2002-02-0343

    Article  CAS  PubMed  Google Scholar 

  25. Rees DC, Cox M, Clegg JB (1995) World distribution of factor V Leiden. Lancet 346(8983):1133–1134

    Article  CAS  PubMed  Google Scholar 

  26. Segers K, Dahlback B, Nicolaes GA (2007) Coagulation factor V and thrombophilia: background and mechanisms. Thromb Haemost 98(3):530–542

    Article  CAS  PubMed  Google Scholar 

  27. Gregg JP, Yamane AJ, Grody WW (1997) Prevalence of the factor V-Leiden mutation in four distinct American ethnic populations. Am J Med Genet 73(3):334–336

    Article  CAS  PubMed  Google Scholar 

  28. Ridker PM, Miletich JP, Hennekens CH, Buring JE (1997) Ethnic distribution of factor V Leiden in 4047 men and women. Implications for venous thromboembolism screening. JAMA 277(16):1305–1307

    Article  CAS  PubMed  Google Scholar 

  29. Pajič T (2010) Factor V Leiden and FII 20210 testing in thromboembolic disorders. Clin Chem Lab Med 48(Suppl 1):S79–S87. https://doi.org/10.1515/cclm.2010.372

    Article  PubMed  Google Scholar 

  30. Koster T, Rosendaal FR, de Ronde H, Briet E, Vandenbroucke JP, Bertina RM (1993) Venous thrombosis due to poor anticoagulant response to activated protein C: Leiden thrombophilia study. Lancet 342(8886–8887):1503–1506

    Article  CAS  PubMed  Google Scholar 

  31. Svensson PJ, Dahlback B (1994) Resistance to activated protein C as a basis for venous thrombosis. N Engl J Med 330(8):517–522

    Article  CAS  PubMed  Google Scholar 

  32. Alfirevic ZSA-M, Nikolac N, Sobocan N, Alfirevic I, Stefanovic M et al (2010) Frequency of factor II G20210A, factor V Leiden, MTHFR C677T and PAI-1 5G/4G polymorphism in patients with venous thromboembolism: Croatian case-control study. Biochem Med 20(2):229–235

    Article  CAS  Google Scholar 

  33. Bedencic M, Bozic M, Peternel P, Stegnar M (2008) Major and potential prothrombotic genotypes in patients with venous thrombosis and in healthy subjects from Slovenia. Pathophysiol Haemost Thromb 36(2):58–63

    Article  PubMed  Google Scholar 

  34. Meglic L, Stegnar M, Milanez T, Bozic M, Peterlin B, Peternel P, Novak-Antolic Z (2003) Factor V Leiden, prothrombin 20210G → A, methylenetetrahydrofolate reductase 677C → T and plasminogen activator inhibitor 4G/5G polymorphism in women with pregnancy-related venous thromboembolism. Eur J Obstet Gynecol Reprod Biol 111(2):157–163

    Article  CAS  PubMed  Google Scholar 

  35. Zoller B, Hillarp A, Berntorp E, Dahlback B (1997) Activated protein C resistance due to a common factor V gene mutation is a major risk factor for venous thrombosis. Annu Rev Med 48:45–58

    Article  CAS  PubMed  Google Scholar 

  36. Lippi G, Danese E, Favaloro EJ, Montagnana M, Franchini M (2015) Diagnostics in venous thromboembolism: from origin to future prospects. Semin Thromb Hemost 41(04):374–381

    Article  PubMed  Google Scholar 

  37. Griffin JH, Evatt B, Wideman C, Fernandez JA (1993) Anticoagulant protein C pathway defective in majority of thrombophilic patients. Blood 82(7):1989–1993

    Article  CAS  PubMed  Google Scholar 

  38. Poort SR, Rosendaal FR, Reitsma PH, Bertina RM (1996) A common genetic variation in the 3′-untranslated region of the prothrombin gene is associated with elevated plasma prothrombin levels and an increase in venous thrombosis. Blood 88(10):3698–3703

    Article  CAS  PubMed  Google Scholar 

  39. Gehring NH, Frede U, Neu-Yilik G, Hundsdoerfer P, Vetter B, Hentze MW, Kulozik AE (2001) Increased efficiency of mRNA 3′ end formation: a new genetic mechanism contributing to hereditary thrombophilia. Nat Genet 28(4):389–392

    Article  CAS  PubMed  Google Scholar 

  40. Rosendaal FR, Doggen CJ, Zivelin A, Arruda VR, Aiach M, Siscovick DS, Hillarp A, Watzke HH, Bernardi F, Cumming AM, Preston FE, Reitsma PH (1998) Geographic distribution of the 20210 G to A prothrombin variant. Thromb Haemost 79(4):706–708

    Article  CAS  PubMed  Google Scholar 

  41. Martinelli I, Bucciarelli P, Margaglione M, De Stefano V, Castaman G, Mannucci PM (2000) The risk of venous thromboembolism in family members with mutations in the genes of factor V or prothrombin or both. Br J Haematol 111(4):1223–1229

    CAS  PubMed  Google Scholar 

  42. Emmerich J, Rosendaal FR, Cattaneo M, Margaglione M, De Stefano V, Cumming T, Arruda V, Hillarp A, Reny JL (2001) Combined effect of factor V Leiden and prothrombin 20210A on the risk of venous thromboembolism – pooled analysis of 8 case-control studies including 2310 cases and 3204 controls. Study Group for Pooled-Analysis in Venous Thromboembolism. Thromb Haemost 86(3):809–816

    CAS  PubMed  Google Scholar 

  43. Seligsohn U, Lubetsky A (2001) Genetic susceptibility to venous thrombosis. N Engl J Med 344(16):1222–1231

    Article  CAS  PubMed  Google Scholar 

  44. Makris M, Preston FE, Beauchamp NJ, Cooper PC, Daly ME, Hampton KK, Bayliss P, Peake IR, Miller GJ (1997) Co-inheritance of the 20210A allele of the prothrombin gene increases the risk of thrombosis in subjects with familial thrombophilia. Thromb Haemost 78(6):1426–1429

    Article  CAS  PubMed  Google Scholar 

  45. Varga E, Kujovich J (2012) Management of inherited thrombophilia: guide for genetics professionals. Clin Genet 81(1):7–17. https://doi.org/10.1111/j.1399-0004.2011.01746.x

    Article  CAS  PubMed  Google Scholar 

  46. Leroyer C, Mercier B, Oger E, Chenu E, Abgrall JF, Ferec C, Mottier D (1998) Prevalence of 20210 A allele of the prothrombin gene in venous thromboembolism patients. Thromb Haemost 80(1):49–51

    CAS  PubMed  Google Scholar 

  47. Tosetto A, Frezzato M, Rodeghiero F (1995) Family history and inherited thrombophilia. Br J Haematol 89(1):227–228

    Article  CAS  PubMed  Google Scholar 

  48. Howard TE, Marusa M, Boisza J, Young A, Sequeira J, Channell C, Guy C, Benson E, Duncan A (1998) The prothrombin gene 3′-untranslated region mutation is frequently associated with factor V Leiden in thrombophilic patients and shows ethnic-specific variation in allele frequency. Blood 91(3):1092

    Article  CAS  PubMed  Google Scholar 

  49. Brown K, Luddington R, Williamson D, Baker P, Baglin T (1997) Risk of venous thromboembolism associated with a G to A transition at position 20210 in the 3′-untranslated region of the prothrombin gene. Br J Haematol 98(4):907–909

    Article  CAS  PubMed  Google Scholar 

  50. Segal JB, Brotman DJ, Emadi A, Necochea AJ, Samal L, Wilson LM, Crim MT, Bass EB (2009) Outcomes of genetic testing in adults with a history of venous thromboembolism. Evid Rep Technol Assess (Full Rep) 180:1–162

    Google Scholar 

  51. Emadi A, Crim MT, Brotman DJ, Necochea AJ, Samal L, Wilson LM, Bass EB, Segal JB (2010) Analytic validity of genetic tests to identify factor V Leiden and prothrombin G20210A. Am J Hematol 85(4):264–270

    Article  CAS  PubMed  Google Scholar 

  52. Simundic AM, Topic E, Stefanovic M (2003) Detection of factor V Leiden by PCR-SSCP using GMA precast Elchrom scientific gels. Clin Appl Thromb Hemost 9(3):227–231

    Article  CAS  PubMed  Google Scholar 

  53. Bianchi M, Emanuele E, Davin A, Gagliardi S, Cova E, Meli V, Trotti R, Cereda C (2010) Comparison of three methods for genotyping of prothrombotic polymorphisms. Clin Exp Med 10(4):269–272. https://doi.org/10.1007/s10238-010-0096-3

    Article  CAS  PubMed  Google Scholar 

  54. Lyondagger E, Millsondagger A, Phan T, Wittwer CT (1998) Detection and identification of base alterations within the region of factor V Leiden by fluorescent melting curves. Mol Diagn 3(4):203–209

    Article  CAS  PubMed  Google Scholar 

  55. Albagoush SA, Koya S, Chakraborty RK, Schmidt AE (2022) Factor V Leiden mutation. In: StatPearls. StatPearls Publishing Copyright © 2022. StatPearls Publishing LLC, Treasure Island

    Google Scholar 

  56. Stevens SM, Woller SC, Bauer KA, Kasthuri R, Cushman M, Streiff M, Lim W, Douketis JD (2016) Guidance for the evaluation and treatment of hereditary and acquired thrombophilia. J Thromb Thrombolysis 41(1):154–164. https://doi.org/10.1007/s11239-015-1316-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Cooper PC, Rezende SM (2007) An overview of methods for detection of factor V Leiden and the prothrombin G20210A mutations. Int J Lab Hematol 29(3):153–162. https://doi.org/10.1111/j.1751-553X.2007.00892.x

    Article  CAS  PubMed  Google Scholar 

  58. Bonetta L (2005) Prime time for real-time PCR. Nat Methods 2:305–312

    Article  CAS  Google Scholar 

  59. Livak KJ, Flood SJ, Marmaro J, Giusti W, Deetz K (1995) Oligonucleotides with fluorescent dyes at opposite ends provide a quenched probe system useful for detecting PCR product and nucleic acid hybridization. PCR Methods Appl 4(6):357–362

    Article  CAS  PubMed  Google Scholar 

  60. Sevall JS (2001) Rapid allelic discrimination from real-time DNA amplification. Methods (San Diego) 25(4):452–455

    Article  CAS  Google Scholar 

  61. Applied Biosystems (2010) Genotyping experiments. In: Applied biosystems real-time PCR Systems Reagent Guide, vol Part Number 4387787 Rev. B 07/2010. Applied Biosystems, pp 3–15

    Google Scholar 

  62. Applied Biosystems (2017) TaqMan® SNP Genotyping Assays USER GUIDE. In: TaqMan® SNP Genotyping Assays vol Publication Number MAN0009593 Revision B.0. vol Revision B.0. Applied Biosystems, Thermo Fisher Scientific, pp 1–72

    Google Scholar 

  63. Yao Y, Nellaker C, Karlsson H (2006) Evaluation of minor groove binding probe and Taqman probe PCR assays: Influence of mismatches and template complexity on quantification. Mol Cell Probes 20(5):311–316

    Article  CAS  PubMed  Google Scholar 

  64. Spector EB, Grody WW, Matteson CJ, Palomaki GE, Bellissimo DB, Wolff DJ, Bradley LA, Prior TW, Feldman G, Popovich BW, Watson MS, Richards CS (2005) Technical standards and guidelines: venous thromboembolism (Factor V Leiden and prothrombin 20210G >A testing): a disease-specific supplement to the standards and guidelines for clinical genetics laboratories. Genet Med 7(6):444–453

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tadej Pajič .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Science+Business Media, LLC, part of Springer Nature

About this protocol

Check for updates. Verify currency and authenticity via CrossMark

Cite this protocol

Pajič, T. (2023). Testing for Factor V Leiden (FVL) and Prothrombin G20210A Genetic Variants. In: Favaloro, E.J., Gosselin, R.C. (eds) Hemostasis and Thrombosis. Methods in Molecular Biology, vol 2663. Humana, New York, NY. https://doi.org/10.1007/978-1-0716-3175-1_14

Download citation

  • DOI: https://doi.org/10.1007/978-1-0716-3175-1_14

  • Published:

  • Publisher Name: Humana, New York, NY

  • Print ISBN: 978-1-0716-3174-4

  • Online ISBN: 978-1-0716-3175-1

  • eBook Packages: Springer Protocols

Publish with us

Policies and ethics