When is a factor XIII assay indicated, and what is factor XIII's relation to myocardial infarction?

Updated: Feb 07, 2020
  • Author: Bishnu Prasad Devkota, MD, MHI, FRCS(Edin), FRCS(Glasg), FACP; Chief Editor: Eric B Staros, MD  more...
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Screening for factor XIII is carried out when the enzyme's presence is suspected.


Neither prothrombin time (PT; international normalized ratio [INR]) nor partial thromboplastin time (PTT) is affected by factor XIII deficiency. Clots are soluble in 5-molar urea. [2] Plasma factor XIII also plays a role in wound healing and tissue repair, and the enzyme is essential in maintaining pregnancy.

When activated by thrombin, factor XIIIa forms an insoluble clot by causing cross-linkage between fibrin molecules. If a clot has not been stabilized by factor XIIIa, it is soluble in 5 mol/L urea; a stabilized clot is resistant to this. [9]

Although measurement of factor XIII levels is not considered routine, patients with an unexplained tendency to bleed may be considered for this screen. The enzyme is very specific for monocytes and macrophages, so identification and classification of malignant diseases involving these cells can be carried out by determining whether or not factor XIII is present. [10]

A study by Tala et al found that factor XIII may be a useful biomarker for deep venous thrombosis (DVT) in critically ill adolescents. Plasma analysis from 59 such patients indicated a link between DVT and higher and lower levels of thrombin-antithrombin complex and factor XIII, respectively. The investigators also reported an association between factor XIII and clinically relevant bleeding in the cohort (odds ratio = 0.27). [11]

A study by Ambroziak et al indicated that in persons under age 50 years, increased factor XIII activity correlates with a greater risk of myocardial infarction (MI). The investigators found that study patients under age 50 years with MI had a factor XIII level of 126.2 U/dL, compared with 109.6 U/dL in healthy controls under age 50 years and 119.8 U/dL in patients with MI aged 50 years or older. [12]

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