Free coagulase detection: For which assay is the plasma coagulase-reacting factor (CRF) required to demonstrate Staphylococcus aureus coagulase activity?

Introduction / Context:
Coagulase exists in two forms: bound (clumping factor) and free coagulase. Understanding the role of the plasma cofactor—coagulase-reacting factor (CRF)—is essential for selecting the appropriate diagnostic test in the lab.

Given Data / Assumptions:

• Slide test detects clumping factor directly on the bacterial surface.
• Tube test detects free coagulase requiring CRF in plasma to form staphylothrombin.
• Precipitation tests are not designed for coagulase detection.

Concept / Approach:
In the tube coagulase test, free coagulase reacts with CRF present in plasma to convert fibrinogen to fibrin, forming a clot. The slide test bypasses CRF because it measures surface-bound clumping factor that directly agglutinates fibrinogen.

Step-by-Step Solution:
Identify which form of coagulase needs CRF: free coagulase. Match to assay: tube coagulase detects free coagulase via clotting. Exclude slide coagulase (bound coagulase) and unrelated precipitation tests. Select “tube coagulase test.”

Verification / Alternative check:
Failure to clot in the tube test with rabbit plasma suggests absence of free coagulase or technical issues; repeating with fresh plasma confirms CRF availability.

Why Other Options Are Wrong:

• Slide test: independent of CRF; detects clumping factor.
• Precipitation/None: not applicable to coagulase mechanisms.

Common Pitfalls:
Reading tube tests too early and missing delayed clot formation; incubate and recheck up to 24 hours if clinically necessary.

Final Answer:
tube coagulase test