1
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Ceglédi A, Dolgos J, Fekete M, Gopcsa L, Várkonyi A, Vilimi B, Mikala G, Bodó I. Delayed spontaneous remission of acquired factor V inhibitor refractory to immunosuppressive therapy with pregnancy-associated improvement. Pathol Oncol Res 2023; 29:1611250. [PMID: 37334173 PMCID: PMC10272408 DOI: 10.3389/pore.2023.1611250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023]
Abstract
Introduction: Acquired factor V inhibitor (AFVI) is a rare autoimmune bleeding disorder. The treatment of AFVI is challenging, and patients often require both bleeding control and inhibitor eradication. Methods: We conducted a retrospective analysis of the medical records of a 35-year-old Caucasian woman who presented with severe AFVI-induced bleeding and subsequent immunosuppressive therapy. Results: To provide haemostasis, rFVIIa was given with good efficacy. The patient was treated with various combinations of immunosuppressive regimens over the course of 2.5 years, including plasmapheresis plus immunoglobulins, dexamethasone + rituximab, cyclophosphamide + dexamethasone + rituximab + cyclosporine, cyclosporin + sirolimus + cyclophosphamide + dexamethasone, bortezomib + sirolimus + methylprednisolone, and sirolimus + mycophenolate mofetil. Although these treatment modalities resulted in intermittent partial reversals of AFVI over 2.5 years, eventually the inhibitor became therapy-resistant. However, following the discontinuation of all immunosuppressive therapy, the patient experienced a partial spontaneous remission, which was followed by a pregnancy. During the pregnancy, the FV activity increased to 54% and the coagulation parameters returned to normal levels. The patient underwent Caesarean section without any bleeding complications and delivered a healthy child. Discussion: The use of an activated bypassing agent for bleeding control is effective in patients with severe AFVI. The presented case is unique because the treatment regimens included multiple combinations of immunosuppressive agents. This demonstrates that AFVI patients may undergo spontaneous remission even after multiple courses of ineffective immunosuppressive protocols. Additionally, pregnancy-associated improvement of AFVI is an important finding that warrants further investigation.
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Affiliation(s)
- Andrea Ceglédi
- Departments of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus, Budapest, Hungary
| | - János Dolgos
- Departments of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus, Budapest, Hungary
| | - Mónika Fekete
- Department of Public Health, Semmelweis University, Budapest, Hungary
| | - László Gopcsa
- Departments of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus, Budapest, Hungary
| | - Andrea Várkonyi
- Departments of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus, Budapest, Hungary
| | - Beáta Vilimi
- Departments of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus, Budapest, Hungary
| | - Gábor Mikala
- Departments of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus, Budapest, Hungary
| | - Imre Bodó
- Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, United States
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2
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Goulenok T, Vasco C, Faille D, Ajzenberg N, De Raucourt E, Dupont A, Frere C, James C, Rabut E, Rugeri L, Schleinitz N, Sacré K, Papo T. Acquired factor V inhibitor: a nation-wide study of 38 patients. Br J Haematol 2021; 192:892-899. [PMID: 33471937 DOI: 10.1111/bjh.17308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
Acquired factor V inhibitor (AFVI) is an extremely rare disorder that may cause severe bleeding. To identify factors associated with bleeding risk in AFVI patients, a national, multicentre, retrospective study was made including all AFVI patients followed in 21 centres in France between 1988 and 2015. All patients had an isolated factor V (FV) deficiency <50% associated with inhibitor activity. Patients with constitutional FV deficiency and other causes of acquired coagulation FV deficiencies were excluded. The primary outcome was incident bleeding and factors associated with the primary outcome were identified. Thirty-eight (74 [36-100] years, 42·1% females) patients with AFVI were analysed. Bleeding was reported in 18 (47·4%) patients at diagnosis and in three (7·9%) during follow-up (7 [0·2-48.7] months). At diagnosis, FV was <10% in 31 (81·6%) patients. Bleeding at diagnosis was associated with a prolonged prothrombin time that strongly correlated with the AFVI level measured in plasma {r = 0·63, 95% confidence interval (CI) [0·36-0·80], P < 0·05}. Bleeding onset during follow-up was associated with a slow AFVI clearance (P < 0·001). The corresponding receiver operating characteristics curve showed that AFVI clearance was predictive of bleeding onset with an AFVI clearance of seven months with a sensitivity of 100% (95% CI: 29-100) and a specificity of 86% (95% CI: 57-98, P = 0·02). Kaplan-Meier analysis showed that AFVI clearance >7 months increased the risk of bleeding by 8 (95% CI: [0·67-97], P = 0·075). Prothrombin time at diagnosis and time for clearance of FV inhibitor during follow-up are both associated with bleeding in patients with AFVI.
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Affiliation(s)
- Tiphaine Goulenok
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Claire Vasco
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Dorothée Faille
- Département d'Hématologie et d'Immunologie biologique, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nadine Ajzenberg
- Département d'Hématologie et d'Immunologie biologique, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Emmanuelle De Raucourt
- Service d'Hématologie Immunologie biologique, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Annabelle Dupont
- Departement d'Hématologie et Transfusion, Pôle de Biologie Pathologie Génétique, CHU Lille, Univ. Lille, Institut Pasteur de Lille, Inserm U1011- EGID, Lille, France
| | - Corinne Frere
- Service d'Hématologie biologique, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Chloé James
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | - Lucia Rugeri
- Service d'Hématologie biologique et d'Hémostase clinique, Hôpital Femme Mère Enfant, Hospices civils de Lyon, Lyon, France
| | - Nicolas Schleinitz
- Département de Médecine Interne, Hôpital de la Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Karim Sacré
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France.,INSERM U1149, Paris, France
| | - Thomas Papo
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France.,INSERM U1149, Paris, France
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3
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Yanagiya R, Kanouchi K, Toubai T, Yamada A, Aizawa K, Shiono Y, Ito S, Ishizawa K. Plasma Exchange as an Initial Treatment for Severe Bleeding Induced by Acquired Factor V Deficiency: A Case Report and Mini Literature Review. Acta Haematol 2020; 144:82-87. [PMID: 32784304 DOI: 10.1159/000505770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 12/22/2022]
Abstract
Acquired factor V deficiency (AFVD) is a rare autoimmune bleeding disorder. Unlike acquired hemophilia, bypass therapies with recombinant activated factor VII and activated prothrombin complex concentrates are ineffective for severe bleeding due to AFVD. Although several treatment strategies have been attempted, a standard of care for severe hemorrhage induced by AFVD is lacking. Herein, we report a case of AFVD with severe bleeding that responded to plasma exchange (PE) combined with immunosuppression. We also reviewed previously reported AFVD cases with severe hemorrhage and suggest that PE may be an effective initial treatment for AFVD-induced severe hemorrhage.
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Affiliation(s)
- Ryo Yanagiya
- Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology (Third Internal Medicine), Yamagata University, Yamagata, Japan
| | - Kazunori Kanouchi
- Department of Clinical Laboratory, Yamagata University Hospital, Yamagata, Japan
| | - Tomomi Toubai
- Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology (Third Internal Medicine), Yamagata University, Yamagata, Japan
| | - Akane Yamada
- Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology (Third Internal Medicine), Yamagata University, Yamagata, Japan
| | - Keiko Aizawa
- Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology (Third Internal Medicine), Yamagata University, Yamagata, Japan
| | - Yosuke Shiono
- Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology (Third Internal Medicine), Yamagata University, Yamagata, Japan
| | - Satoshi Ito
- Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology (Third Internal Medicine), Yamagata University, Yamagata, Japan
| | - Kenichi Ishizawa
- Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology (Third Internal Medicine), Yamagata University, Yamagata, Japan,
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4
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Masciana J, Peterson N, Chretin J. Acquired factor V inhibitors after allogeneic hematopoietic stem cell transplantation in a dog. J Vet Intern Med 2020; 34:2096-2100. [PMID: 32686109 PMCID: PMC7517841 DOI: 10.1111/jvim.15845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/16/2020] [Accepted: 06/26/2020] [Indexed: 01/07/2023] Open
Abstract
Objective Describe the clinical course and management of a dog that underwent hematopoietic stem cell transplantation (HSCT) for treatment of B‐cell lymphoma and developed acquired circulating factor V (FV) inhibitors. Case Summary An 8‐year‐old male castrated Briard dog diagnosed with lymphoma (IVb, B‐cell) presented for allogeneic HSCT. Despite multiple platelet, fresh frozen plasma, and red blood cell transfusions prolonged recovery and clinical bleeding occurred. Circulating acquired FV inhibitors were identified and hemorrhage subsequently was managed by immunosuppression. The dog was discharged when clinical resolution of bleeding was achieved. New or Unique Information Provided This case report describes a dog undergoing curative intent treatment for lymphoma, and subsequently acquiring factor inhibition, and was successfully managed. Specific coagulation screening to assess for coagulation factor deficiencies or inhibitors is essential in the diagnosis and treatment of patients with refractory bleeding or only transient response to blood transfusion.
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Affiliation(s)
- Joseph Masciana
- VCA West Los Angeles - Emergency and Critical Care, Los Angeles, California, USA
| | - Nathan Peterson
- VCA West Los Angeles - Emergency and Critical Care, Los Angeles, California, USA
| | - John Chretin
- VCA West Los Angeles - Oncology, Los Angeles, California, USA
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5
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Franchini M, Marano G, Cruciani M, Mengoli C, Pati I, Masiello F, Veropalumbo E, Pupella S, Vaglio S, Liumbruno GM. Advances in managing rare acquired bleeding disorders. Expert Rev Hematol 2020; 13:599-606. [PMID: 32286895 DOI: 10.1080/17474086.2020.1756259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Rare acquired bleeding disorders include a wide spectrum of coagulopathies characterized by spontaneous or post-trauma and post-surgery hemorrhages in patients without a previous personal or family history of bleeding. AREAS COVERED This review, based on a Medline/PubMed search during the last 20 years, will focus mainly on rare acquired bleeding disorders caused by autoantibodies against coagulation factors, including autoantibodies against factor VIII (acquired hemophilia A), von Willebrand factor (acquired von Willebrand syndrome) and other coagulation factors (factors V, X, XI, and XIII). The pathogenic, laboratory, and clinical features of these rare hemorrhagic conditions will be discussed, with particular attention to their management. EXPERT OPINION The treatment of rare acquired bleeding disorders includes the control of bleeding and the elimination of the autoantibody and of the underlying disease, when present. As the bleeding clinical phenotype is often severe, the management of affected patients is particularly challenging. Thus, while an early diagnosis of the acquired coagulopathy is essential to start the most appropriate treatment and to improve patients' outcomes, the support of specialized centers is equally important to provide a correct management of such complicated cases.
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Affiliation(s)
- Massimo Franchini
- Italian National Blood Centre, National Institute of Health , Rome, Italy.,Department of Hematology and Transfusion Medicine, Carlo Poma Hospital , Mantua, Italy
| | - Giuseppe Marano
- Italian National Blood Centre, National Institute of Health , Rome, Italy
| | - Mario Cruciani
- Italian National Blood Centre, National Institute of Health , Rome, Italy.,Infection Control Committee and Antibiotic Stewardship Programme, AULSS9 Scaligera , Verona, Italy
| | - Carlo Mengoli
- Italian National Blood Centre, National Institute of Health , Rome, Italy
| | - Ilaria Pati
- Italian National Blood Centre, National Institute of Health , Rome, Italy
| | - Francesca Masiello
- Italian National Blood Centre, National Institute of Health , Rome, Italy
| | - Eva Veropalumbo
- Italian National Blood Centre, National Institute of Health , Rome, Italy
| | - Simonetta Pupella
- Italian National Blood Centre, National Institute of Health , Rome, Italy
| | - Stefania Vaglio
- Italian National Blood Centre, National Institute of Health , Rome, Italy
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Kadohira Y, Yamada S, Hayashi T, Morishita E, Asakura H, Ichinose A. A discrepancy between prothrombin time and Normotest (Hepaplastintest) results is useful for diagnosis of acquired factor V inhibitors. Int J Hematol 2018; 108:145-150. [PMID: 29611057 DOI: 10.1007/s12185-018-2453-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 11/27/2022]
Abstract
Acquired coagulation factor inhibitors are rare. Among them, coagulation factor V (FV) inhibitor is particularly uncommon and presents with variable clinical manifestations. Certain acquired FV inhibitor patients have only mild bleeding or, in select cases, no symptoms at all, leading to spontaneous recovery. Others have life-threatening bleeding that requires medical attention. Thus, a prompt decision regarding diagnosis and clinical intervention is crucial for such patients. In five acquired FV inhibitor cases treated in our facility, each patient had a malignancy as an underlying disease and all unexpectedly showed prolongation of both prothrombin time (PT) and activated partial thromboplastin time (APTT). They all also displayed a discrepancy between PT and Normotest (Hepaplastintest, HPT) results. All but one patient experienced no bleeding at the time of diagnosis and achieved spontaneous recovery in 1-3 weeks. The patient with bleeding symptoms received plasma exchanges and a platelet transfusion. Useful markers in diagnosing the presence of an acquired FV inhibitor were a sudden prolongation of PT and APTT, and a discrepancy between the PT/APTT and HPT assays. Spontaneous recovery can be expected for patients with only minor bleeding.
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Affiliation(s)
- Yasuko Kadohira
- Department of Hematology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Shinya Yamada
- Department of Hematology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tomoe Hayashi
- Department of Hematology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Eriko Morishita
- Department of Hematology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hidesaku Asakura
- Department of Hematology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
- Japanese Collaborative Research Group on Autoimmune Haemorrhaphilia Supported by the Japanese Ministry of Health, Labor and Welfare, Yamagata, Japan
| | - Akitada Ichinose
- Japanese Collaborative Research Group on Autoimmune Haemorrhaphilia Supported by the Japanese Ministry of Health, Labor and Welfare, Yamagata, Japan
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School, Yamagata, Japan
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7
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Fatal hemorrhage due to a spontaneous factor V inhibitor with lupus anticoagulant properties. Blood Coagul Fibrinolysis 2016; 28:407-410. [PMID: 27676645 DOI: 10.1097/mbc.0000000000000603] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
: Factor V inhibitors are rare and have varied clinical presentations. We report on a 76-year-old female admitted to the hospital for pneumonia and treated with multiple antibiotics. Her baseline prothrombin time was 15.6 s and the activated partial thromboplastin time was 35 s. On admission day 10, she developed arm weakness and brain imaging showed a subdural hematoma. The prothrombin time was now 59.1 s with an activated partial thromboplastin time of more than 160 s and a normal thrombin time. A mixing study did not correct the clotting times and coagulation factor assays showed a nonspecific inhibition pattern. Only factor V activity remained low with serial dilutions, however, and a 70 Bethesda Unit inhibitor was identified. Aggressive supportive care was initiated but the patient succumbed to the effects of the intracranial hemorrhage. Factor V inhibitors may display lupus anticoagulant properties and may cause catastrophic bleeding. Our case illustrates that these inhibitors can arise quickly and supports an association with antibiotics.
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8
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Deficit acquis en facteur V après antibiothérapie. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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9
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Anderson D, Phan C, Johnston WS, Siddiqi ZA. Rituximab in refractory myasthenia gravis: a prospective, open-label study with long-term follow-up. Ann Clin Transl Neurol 2016; 3:552-5. [PMID: 27386504 PMCID: PMC4931720 DOI: 10.1002/acn3.314] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 04/05/2016] [Indexed: 01/07/2023] Open
Abstract
We examined the clinical effectiveness of rituximab in fourteen patients with refractory myasthenia gravis (MG). Manual muscle testing (MMT) score was recorded at baseline and followed during the course of the study. Steroid dose, frequency of intravenous immunoglobulin (IVIG) infusions, and plasma exchange (PLEX) were also monitored throughout the duration of the study. All patients responded dramatically to rituximab, as measured by a change in MMT score, prednisone dose, or the frequency of IVIG infusions or PLEX. Rituximab appears safe and effective for the treatment of refractory MG. It should be considered as a therapeutic option in refractory patients.
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Affiliation(s)
- Dustin Anderson
- Department of Medicine (Neurology) University of Alberta Edmonton Alberta Canada T6G 2G3
| | - Cecile Phan
- Department of Medicine (Neurology) University of Alberta Edmonton Alberta Canada T6G 2G3
| | - Wendy S Johnston
- Department of Medicine (Neurology) University of Alberta Edmonton Alberta Canada T6G 2G3
| | - Zaeem A Siddiqi
- Department of Medicine (Neurology) University of Alberta Edmonton Alberta Canada T6G 2G3
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10
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Kitazawa A, Misawa H, Nagahori K, Koda R, Yoshino A, Kawamoto S, Takeda T. Acquired Factor V Inhibitors in a Patient with End-stage Renal Disease. Intern Med 2016; 55:3505-3509. [PMID: 27904118 PMCID: PMC5216152 DOI: 10.2169/internalmedicine.55.7369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We report a case of acquired factor V inhibitors (AFVIs) in a patient with end-stage renal disease receiving warfarin therapy for atrial fibrillation. A 72-year-old Japanese man was admitted to our hospital complaining of tarry stools and abdominal pain. The laboratory findings revealed eosinophilia (52.1%), prolonged activated partial thromboplastin time (APTT) (98 s), PT (84 s), a factor V (FV) activity of <3%, and an FV inhibitor level of 6 Bethesda units/mL. After administration of prednisolone was started, his coagulation findings improved. However, his renal failure progressed, and he ultimately required chronic hemodialysis. This is the first case of AFVIs in a patient starting hemodialysis for end-stage renal disease.
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11
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Cui QY, Shen HS, Wu TQ, Chen HF, Yu ZQ, Wang ZY. Development of acquired factor V inhibitor after treatment with ceftazidime: a case report and review of the literature. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:2395-8. [PMID: 25987837 PMCID: PMC4422287 DOI: 10.2147/dddt.s68682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We report the case of a 59-year-old Chinese man who showed an asymptomatic coagulation factor V deficiency pattern after second intravenous treatment with ceftazidime. Normal pooled plasma failed to correct the abnormalities in a mixing test, and the presence of factor V inhibitor was confirmed by the Bethesda method. The coagulopathy was not corrected by transfusion of fresh frozen plasma and prothrombin complex concentrate, but rather by treatment with prednisone and withdrawal of dubious drugs. The findings reported here should prompt clinicians to watch for drug-induced coagulation factor deficiency.
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Affiliation(s)
- Qing-ya Cui
- Department of Hematology, PLA 100th Hospital, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Hong-shi Shen
- Department of Hematology, PLA 100th Hospital, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Tian-qin Wu
- Department of Hematology, PLA 100th Hospital, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Hai-fei Chen
- Department of Hematology, PLA 100th Hospital, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Zi-qiang Yu
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Zhao-yue Wang
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
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12
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Complete response of acquired FV inhibitor to rituximab. Int J Hematol 2015; 101:421-2. [DOI: 10.1007/s12185-015-1742-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 01/14/2015] [Accepted: 01/15/2015] [Indexed: 11/26/2022]
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13
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Thrombin generation in a patient with an acquired high-titre factor V inhibitor. Blood Coagul Fibrinolysis 2015; 26:81-7. [DOI: 10.1097/mbc.0000000000000181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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14
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Ardillon L, Lefrançois A, Graveleau J, Fouassier M, Ternisien C, Sigaud M, Fretigny M, Archambeaud I, Trossaërt M. Management of bleeding in severe factor V deficiency with a factor V inhibitor. Vox Sang 2014; 107:97-9. [DOI: 10.1111/vox.12134] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 12/20/2013] [Accepted: 12/20/2013] [Indexed: 12/23/2022]
Affiliation(s)
- L. Ardillon
- Haemophilia Center; University Hospital; Nantes France
| | - A. Lefrançois
- Haemophilia Center; University Hospital; Nantes France
| | - J. Graveleau
- Internal Medicine; University Hospital; Nantes France
| | - M. Fouassier
- Haemophilia Center; University Hospital; Nantes France
| | - C. Ternisien
- Haemophilia Center; University Hospital; Nantes France
| | - M. Sigaud
- Haemophilia Center; University Hospital; Nantes France
| | - M. Fretigny
- Laboratory of Hematology; University Hospital; Lyon France
| | | | - M. Trossaërt
- Haemophilia Center; University Hospital; Nantes France
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15
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Thakar K, Parikh K, Chen Y, Liu D. Isolated factor V deficiency in a patient with elevated PT and aPTT during routine pre-operative laboratory screening. Stem Cell Investig 2014; 1:4. [PMID: 27358851 DOI: 10.3978/j.issn.2306-9759.2014.03.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 02/07/2014] [Indexed: 01/17/2023]
Abstract
Isolated factor V (FV) deficiency is a rare disorder with approximately 150 cases reported in the literature since 1943. Bleeding symptoms from FV deficiency vary widely. FV deficiency usually manifests early in the life. We present a 59-year-old case with FV deficiency discovered during pre-operative laboratory screen.
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Affiliation(s)
- Keyur Thakar
- 1 Division of Hematology & Oncology, Department of Medicine, Westchester Medical Center, Valhalla, NY 10595, USA ; 2 Department of Hematology, Xiamen Zhongshan Hospital, Xiamen University, Xiamen 361004, China ; 3 Henan Tumor Hospital, Zhengzhou University, Zhengzhou 450008, China
| | - Kaushal Parikh
- 1 Division of Hematology & Oncology, Department of Medicine, Westchester Medical Center, Valhalla, NY 10595, USA ; 2 Department of Hematology, Xiamen Zhongshan Hospital, Xiamen University, Xiamen 361004, China ; 3 Henan Tumor Hospital, Zhengzhou University, Zhengzhou 450008, China
| | - Yamei Chen
- 1 Division of Hematology & Oncology, Department of Medicine, Westchester Medical Center, Valhalla, NY 10595, USA ; 2 Department of Hematology, Xiamen Zhongshan Hospital, Xiamen University, Xiamen 361004, China ; 3 Henan Tumor Hospital, Zhengzhou University, Zhengzhou 450008, China
| | - Delong Liu
- 1 Division of Hematology & Oncology, Department of Medicine, Westchester Medical Center, Valhalla, NY 10595, USA ; 2 Department of Hematology, Xiamen Zhongshan Hospital, Xiamen University, Xiamen 361004, China ; 3 Henan Tumor Hospital, Zhengzhou University, Zhengzhou 450008, China
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Paschal RD, Neff AT. Resolution of Hypoprothrombinemia-Lupus Anticoagulant Syndrome (HLAS) after multidrug therapy with rituximab: a case report and review of the literature. Haemophilia 2012; 19:e62-5. [DOI: 10.1111/hae.12027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2012] [Indexed: 12/25/2022]
Affiliation(s)
- R. D. Paschal
- Division of Hematology and Oncology, Department of Internal Medicine; Vanderbilt University Medical Center; Nashville; TN; USA
| | - A. T. Neff
- Division of Hematology and Oncology, Department of Internal Medicine; Vanderbilt University Medical Center; Nashville; TN; USA
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18
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Abstract
The occurrence of an inhibitor against coagulation factor V (FV) is a rare but challenging condition, which may span from asymptomatic laboratory abnormalities to potentially life-threatening bleeding. The onset of FV inhibitors has been associated most frequently in the past with the patients' exposure to topical bovine thrombin administered during surgery procedures. However, since this preparation is no longer used, in this systematic review we have only focused on non-bovine thrombin-related FV inhibitor cases.
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Affiliation(s)
- Massimo Franchini
- Servizio di Immunoematologia e Medicina Trasfusionale, Dipartimento di Patologia e Medicina di Laboratorio, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
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Alcantara M, Ducastelle S, Rugeri L, Dargaud Y. Le déficit acquis en facteur V : une pathologie hémorragique rare à manifestations cliniques variables. Rev Med Interne 2011; 32:e59-61. [DOI: 10.1016/j.revmed.2010.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 04/19/2010] [Accepted: 06/08/2010] [Indexed: 10/19/2022]
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20
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Postoperative bleeding in an elderly patient from acquired factor V inhibitor: rapid response to immunosuppressive therapy. Am J Med Sci 2011; 341:253-6. [PMID: 21289509 DOI: 10.1097/maj.0b013e31820375be] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Acquired factor V inhibitor is a rare but potentially life-threatening hemorrhagic disorder caused by the development of autoantibodies directed against coagulation factor V. The management of acute bleeding and inhibitor eradication is the mainstay of the treatment. The authors report a case of a 79-year-old man who underwent right hip arthroplasty and postoperatively, when on Coumadin for deep venous thrombosis prophylaxis, developed bleeding from the surgical site with a hematoma and abnormal coagulation parameters. Further workup revealed an acquired factor V inhibitor. The approach to treat this rare and challenging disorder is discussed. The patient responded rapidly with disappearance of factor V inhibitor titers after initiation of treatment with rituximab, prednisone and cyclophosphamide.
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22
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Teh PPG, Grigoriadis G, Salem H. Acquired factor V inhibitor. Intern Med J 2010; 40:667-8. [DOI: 10.1111/j.1445-5994.2010.02297.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- P. P. G. Teh
- Department of Clinical Haematology, The Alfred Hospital and Australian Centre for Blood Diseases, Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - G. Grigoriadis
- Department of Clinical Haematology, The Alfred Hospital and Australian Centre for Blood Diseases, Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - H. Salem
- Department of Clinical Haematology, The Alfred Hospital and Australian Centre for Blood Diseases, Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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23
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Wu MT, Pei SN. Development of cephradine-induced acquired factor V inhibitors: a case report. Ann Pharmacother 2010; 44:1673-6. [PMID: 20807866 DOI: 10.1345/aph.1p324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To report a case of cephalosporin-induced factor V inhibitor development, an uncommon but potentially fatal condition characterized by severe hemorrhage. CASE SUMMARY A 71-year-old Chinese man presented with factor V inhibitors after a 7-day cephradine course for a urinary tract infection, characterized by abnormal prothrombin time (PT) and activated partial thromboplastin time (aPTT), gross hematuria, upper gastrointestinal bleeding, and left groin hematoma. Systemic corticosteroid administration restored his factor V activity levels, PT, and aPTT to within normal limits, and hemorrhagic symptoms resolved. Three weeks after successful treatment of bleeding diathesis, he received another 8-day cephradine course for cellulitis. After another 4 weeks, he suffered from recurrent factor V inhibitors presented with abnormal PT, aPTT, and upper gastrointestinal bleeding. The patient eventually died due to hemorrhagic shock despite a second course of corticosteroids. DISCUSSION Cephalosporins are known to cause coagulopathy via hypoprothrombinemia. Another pathway seldom mentioned in the literature is factor V inhibitor induction, which may result in factor V deficiency. In our patient, factor V deficiency due to inhibitors developed each time that the patient received repeated cephradine treatment. According to the Naranjo probability scale, the relation between the formation of factor V inhibitors and cephradine treatment was probable. CONCLUSIONS Because cephalosporins are commonly used for their wide therapeutic index and few adverse effects, iatrogenic complications associated with these drugs may be neglected or underdiagnosed. On the basis of our patient's report, careful review of medical records to avoid reexposure to the offending drug cannot be overemphasized.
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Affiliation(s)
- Men-Tai Wu
- Department of Internal Medicine, Chang-Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan
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24
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Abstract
Acquired inhibitor of factor V is a rare condition with a variety of clinical manifestations, from extremely mild to life threatening haemorrhage. We present a case from our intensive care unit as a reminder of the less common causes of elevated prothombin and activated partial thromboplastin times, and how knowledge of the variable presentation may aid management.
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Affiliation(s)
- C J Morris
- Department of Anaesthesia, Stoke Mandeville Hospital, Buckinghamshire, UK.
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25
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Ness P, Creer M, Rodgers GM, Naoum JJ, Renkens K, Voils SA, Alexander WA. Building an immune-mediated coagulopathy consensus: early recognition and evaluation to enhance post-surgical patient safety. Patient Saf Surg 2009; 3:8. [PMID: 19463180 PMCID: PMC2693115 DOI: 10.1186/1754-9493-3-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Accepted: 05/22/2009] [Indexed: 12/25/2022] Open
Abstract
Topical hemostats, fibrin sealants, and surgical adhesives are regularly used in a variety of surgical procedures involving multiple disciplines. Generally, these adjuncts to surgical hemostasis are valuable means for improving wound visualization, reducing blood loss or adding tissue adherence; however, some of these agents are responsible for under-recognized adverse reactions and outcomes. Bovine thrombin, for example, is a topical hemostat with a long history of clinical application that is widely used alone or in combination with other hemostatic agents. Hematologists and coagulation experts are aware that these agents can lead to development of an immune-mediated coagulopathy (IMC). A paucity of data on the incidence of IMC contributes to under-recognition and leaves many surgeons unaware that this clinical entity, originating from normal immune responses to foreign antigen exposure, requires enhanced post-operative vigilance and judicious clinical judgment to achieve best outcomes. Postoperative bleeding may result from issues such as loosened ties or clips or the occurrence of a coagulopathy due to hemodilution, vitamin K deficiency, disseminated intravascular coagulation (DIC) or post-transfusion, post-shock coagulopathic states. Other causes, such as liver disease, may be ruled out by a careful patient history and common pre-operative liver function tests. Less common are coagulopathies secondary to pathologic immune responses. Such coagulopathies include those that may result from inherent patient problems such as patients with an immune dysfunction related to systemic lupus erythrematosus (SLE) or lymphoma that can invoke antibodies against native coagulation factors. Medical interventions may also provoke antibody formation in the form of self-directed anti-coagulation factor antibodies, that result in problematic bleeding; it is these iatrogenic post-operative coagulopathies, including those associated with bovine thrombin exposure and its clinical context, that this panel was convened to address. The RETACC panel's goal was to attain a logical consensus by reviewing the scientific evidence surrounding IMC and to make recommendations for the clinical recognition, diagnosis and evaluation, and clinical management of these complications. In light of the under-recognition and under-reporting of IMC, and given the associated morbidity, utilization of health care resources, and potential economic impact to hospitals, the panel engaged in a detailed review of peer-reviewed reports of bovine thrombin associated IMC. From that clinical knowledge base, recommendations were developed to guide clinicians in the recognition, diagnosis, and management of this challenging condition.
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Affiliation(s)
- Paul Ness
- Division of Hematology, Johns Hopkins Medicine, 600 North Wolfe Street, Carnegie 667, Baltimore, Maryland 21287, USA.
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William BM. Adjunctive role for recombinant activated factor VII in the treatment of bleeding secondary to a factor V inhibitor. Blood Coagul Fibrinolysis 2008; 19:327-8. [PMID: 18469559 DOI: 10.1097/mbc.0b013e3283001d49] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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