1
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Cherubini F, Buso G, Pini G, Martini G, Muiesan ML. Severe coagulation disorder occurring after broad-spectrum antibiotic therapy in a patient with longstanding infection. Intern Emerg Med 2024:10.1007/s11739-024-03565-z. [PMID: 38472718 DOI: 10.1007/s11739-024-03565-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/11/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Fabio Cherubini
- Department of Clinical and Experimental Sciences, Division of Internal Medicine, ASST Spedali Civili Brescia, University of Brescia, 25121, Brescia, Italy
| | - Giacomo Buso
- Department of Clinical and Experimental Sciences, Division of Internal Medicine, ASST Spedali Civili Brescia, University of Brescia, 25121, Brescia, Italy
- University of Lausanne, Lausanne, Switzerland
| | - Giulia Pini
- Department of Clinical and Experimental Sciences, Division of Internal Medicine, ASST Spedali Civili Brescia, University of Brescia, 25121, Brescia, Italy
| | - Giuliana Martini
- Hemostasis Central Laboratory, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, Division of Internal Medicine, ASST Spedali Civili Brescia, University of Brescia, 25121, Brescia, Italy.
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2
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Rossignon P, Grandjean F, Claessens A, Weynants N. Circulating Inhibitor against Factor X: A Rare Cause of Hemorrhagic Diathesis. Case Rep Hematol 2023; 2023:5510654. [PMID: 38124779 PMCID: PMC10732816 DOI: 10.1155/2023/5510654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Acquired coagulopathies resulting from factor X deficiency are rare and typically associated with amyloidosis or plasma cell dyscrasia. Factor X plays a pivotal role in the coagulation cascade, converting prothrombin into thrombin and facilitating the formation of fibrinogen and thrombus. While its occurrence following common infections is extremely rare, isolated cases have been documented. We present a rare case of bleeding diathesis in a patient with community-acquired pneumonia, where prolonged activated partial thromboplastin time (aPTT) and prothrombin time (PT) led to the diagnosis of an infectious-triggered acquired circulating inhibitor targeting factor X. Prompt treatment with methylprednisolone effectively controlled the inhibitor without recurrence. This case report provides insights into the diagnostic strategies, differential algorithm, and therapeutic approaches for managing this rare coagulopathy.
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Affiliation(s)
- P. Rossignon
- Hematology-Oncology Department and Cardiology Department, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
- Department of Internal Medicine, Erasmus University Hospital, ULB, Brussels, Belgium
| | - F. Grandjean
- Department of Clinical Biology, Department of Endocrinology and Diabetology and Department of Hematology and Oncology, Cliniques du Sud Luxembourg-Vivalia, Arlon, Belgium
| | - A. Claessens
- Department of Clinical Biology, Department of Endocrinology and Diabetology and Department of Hematology and Oncology, Cliniques du Sud Luxembourg-Vivalia, Arlon, Belgium
| | - N. Weynants
- Department of Clinical Biology, Department of Endocrinology and Diabetology and Department of Hematology and Oncology, Cliniques du Sud Luxembourg-Vivalia, Arlon, Belgium
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3
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Arakaki S, Ono S, Kawamata F, Ishino S, Uesato Y, Nakajima T, Nishi Y, Morishima S, Arakaki S, Maeshiro T, Souri M, Ichinose A, Masuzaki H, Takatsuki M. Fatal acquired coagulation factor V deficiency after hepatectomy for advanced hepatocellular carcinoma as a possible immune checkpoint inhibitor-related adverse event: a case report. Surg Case Rep 2023; 9:16. [PMID: 36729240 PMCID: PMC9895589 DOI: 10.1186/s40792-023-01601-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/30/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Atezolizumab plus bevacizumab therapy was recently introduced as the first line for unresectable advanced hepatocellular carcinoma (HCC), but immune-related adverse events (IrAEs) due to atezolizumab are a great concern. Here, we report the case of a patient who developed fatal acquired coagulation factor deficiency after hepatectomy for HCC, treated with atezolizumab and bevacizumab before surgery. CASE PRESENTATION A 70-year-old man received right trisegmentectomy of the liver with hepaticojejunostomy for advanced HCC with bile duct invasion, after atezolizumab and bevacizumab therapy. The patient suffered the sudden onset of severe multiple coagulation factor deficiency (II, V, VII, VIII, IX, X, XI and XII) immediately following reoperation for anastomotic leakage of hepaticojejunostomy, 7 days after hepatectomy. The coagulation factor deficiency did not reverse even with intensive treatment, and the patient died of uncontrollable bleeding 32 days after hepatectomy. An IrAE due to atezolizumab was suspected because the patient had developed the possible IrAE of enthesitis of the right gastrocnemius muscle before surgery, and specific inhibitors against factor V and anti-factor V autoantibodies were detected, leading to an ultimate diagnosis of autoimmune FV/5 deficiency (AiF5D). CONCLUSION Severe acquired coagulopathy should be recognized as a possible life-threatening IrAE when using atezolizumab and bevacizumab for HCC.
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Affiliation(s)
- Shintaro Arakaki
- grid.267625.20000 0001 0685 5104Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215 Japan
| | - Shinichiro Ono
- grid.267625.20000 0001 0685 5104Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215 Japan
| | - Futoshi Kawamata
- grid.267625.20000 0001 0685 5104Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215 Japan
| | - Shinichiro Ishino
- grid.267625.20000 0001 0685 5104Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215 Japan
| | - Yasunori Uesato
- grid.267625.20000 0001 0685 5104Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215 Japan
| | - Tomo Nakajima
- grid.267625.20000 0001 0685 5104Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Yukiko Nishi
- grid.267625.20000 0001 0685 5104Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Satoko Morishima
- grid.267625.20000 0001 0685 5104Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Shingo Arakaki
- grid.267625.20000 0001 0685 5104Department of Infectious, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Tatsuji Maeshiro
- grid.267625.20000 0001 0685 5104Department of Infectious, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Masayoshi Souri
- grid.415828.2The Japanese Collaborative Research Group (JCRG) on Autoimmune Coagulation Factor Deficiency (AiCFD), Japanese Ministry of Health, Labor, and Welfare (MHLW), Tokyo, Japan ,grid.268394.20000 0001 0674 7277Department of Molecular Patho-Biochemistry and Pathobiology, Yamagata University School of Medicine, Yamagata, Japan
| | - Akitada Ichinose
- grid.415828.2The Japanese Collaborative Research Group (JCRG) on Autoimmune Coagulation Factor Deficiency (AiCFD), Japanese Ministry of Health, Labor, and Welfare (MHLW), Tokyo, Japan ,grid.268394.20000 0001 0674 7277Department of Molecular Patho-Biochemistry and Pathobiology, Yamagata University School of Medicine, Yamagata, Japan
| | - Hiroaki Masuzaki
- grid.267625.20000 0001 0685 5104Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Mitsuhisa Takatsuki
- grid.267625.20000 0001 0685 5104Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215 Japan
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4
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Katsuren E, Kohagura K, Kinjyo T, Zamami R, Nakamura T, Oshiro N, Sunagawa Y, Omine K, Kudo Y, Shinzato Y, Osaki T, Souri M, Ichinose A, Yamazato M, Ishida A, Ohya Y. Acquired factor V inhibitor with erythema and eosinophilia in a patient with end-stage renal disease. CEN Case Rep 2023; 12:91-97. [PMID: 35943699 PMCID: PMC9361254 DOI: 10.1007/s13730-022-00725-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/24/2022] [Indexed: 02/04/2023] Open
Abstract
Autoimmune factor V deficiency (AiFVD) is a rare bleeding disorder caused by factor V inhibitors. In this report, we present the case of an 89-year-old man who developed bleeding tendency during surgery to create arteriovenous fistula for hemodialysis. The bleeding tendency developed with prolongation of activated partial thromboplastin and prothrombin time, following drug-induced eruption and eosinophilia. Significant reduction in coagulation factor activity and inhibitory pattern in cross-mixing tests suggested the presence of inhibitors to coagulation factors. Subsequently, we detected a factor V inhibitor and anti-factor V autoantibodies was confirmed using enzyme-linked immunosorbent assay with purified human plasma factor V. Thus, the patient was 'definitely diagnosed' with AiFVD in accordance with the diagnostic criteria enacted by the Japanese Ministry of Health, Labor, and Welfare. The bleeding tendency improved after initiating oral prednisolone 50 mg (1 mg/kg) followed by normalization of activated partial thromboplastin time and prothrombin time at the 34th day. After improving the coagulation system prolongation, the inhibitor and autoantibodies has been eradicated. Since it is suggested that drug-induced immune response can cause AiFVD, AiFVD should be considered in patients who undergo hemodialysis and develop failure of hemostasis and drug-induced eruption.
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Affiliation(s)
- Eisuke Katsuren
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kentaro Kohagura
- Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan.
| | - Takanori Kinjyo
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Ryo Zamami
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
- Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan
| | - Takuto Nakamura
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
- Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan
| | - Nanako Oshiro
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yoshitsugu Sunagawa
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kumiko Omine
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yuki Kudo
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yuki Shinzato
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tsukasa Osaki
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata, 990-9585, Japan
- The Japanese Collaborative Research Group (JCRG) On Autoimmune Acquired Coagulation Factor Deficiencies Supported By the Japanese Ministry of Health, Labor and Welfare (MHLW), Tokyo, Japan
- Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science, 2-2-2, Iida-Nishi, Yamagata, 990-9585, Japan
| | - Masayoshi Souri
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata, 990-9585, Japan
- The Japanese Collaborative Research Group (JCRG) On Autoimmune Acquired Coagulation Factor Deficiencies Supported By the Japanese Ministry of Health, Labor and Welfare (MHLW), Tokyo, Japan
- Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science, 2-2-2, Iida-Nishi, Yamagata, 990-9585, Japan
| | - Akitada Ichinose
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata, 990-9585, Japan
- The Japanese Collaborative Research Group (JCRG) On Autoimmune Acquired Coagulation Factor Deficiencies Supported By the Japanese Ministry of Health, Labor and Welfare (MHLW), Tokyo, Japan
| | - Masanobu Yamazato
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Akio Ishida
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yusuke Ohya
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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5
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Seki T, Tsukagoshi M, Harimoto N, Araki K, Watanabe A, Ishii N, Hagiwara K, Hoshino K, Muranushi R, Kakizaki S, Ogawa Y, Handa H, Shirabe K. Laparoscopic hepatectomy for hepatocellular carcinoma in a patient with congenital factor V deficiency: a case report. Surg Case Rep 2022; 8:202. [PMID: 36271957 PMCID: PMC9588126 DOI: 10.1186/s40792-022-01559-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Factor V (FV) deficiency is an extremely rare disease, with an incidence of 1 in 1 million. The bleeding symptoms are mild, and the prognosis is good; however, the safety of surgical treatment is unclear, because there are few available reports. Herein, we report a case of hepatocellular carcinoma with congenital FV deficiency in a patient who safely underwent laparoscopic hepatectomy. CASE PRESENTATION A 79-year-old man, diagnosed with hepatocellular carcinoma of liver segment 5, with type C cirrhosis and sustained virological response visited our hospital. He had congenital FV deficiency, and blood tests showed coagulation deficiencies with an FV activity of < 2.6%, prothrombin time activity of 11%, and activated partial thromboplastin time of 100.3 s. Surgery and radiofrequency ablation were considered for treatment. Since the tumor was in contact with the Glissonean pedicle 5 + 6, surgery was judged to be superior from the viewpoint of safety and curability. After discussing the safety of the surgery with a hematologist, it was determined that the operation could be performed safely by transfusing sufficient fresh frozen plasma (FFP). Laparoscopic hepatic segment 5 + 6 subsegmental resection was performed with FFP transfusion, fluid restriction, airway pressure control, and central venous pressure reduction to control the bleeding. Bleeding was minimized during the transection of the liver parenchyma and no bleeding tendency was observed. The operative time was 445 min, and the amount of intraoperative bleeding was 171 mL. No complications, such as postoperative bleeding, were observed, and the patient was discharged on the eighth postoperative day. CONCLUSIONS Liver surgery can be performed safely in FV-deficient patients with strict coagulation capacity monitoring and appropriate transfusion of FFP. Preoperative evaluation of cardiac function to determine tolerance to high doses of FFP and ingenuity of surgery and intraoperative management to minimize blood loss are important.
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Affiliation(s)
- Takaomi Seki
- grid.256642.10000 0000 9269 4097Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-15, Showamachi, Maebashi, Gunma 371-8511 Japan
| | - Mariko Tsukagoshi
- grid.256642.10000 0000 9269 4097Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-15, Showamachi, Maebashi, Gunma 371-8511 Japan
| | - Norifumi Harimoto
- grid.256642.10000 0000 9269 4097Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-15, Showamachi, Maebashi, Gunma 371-8511 Japan
| | - Kenichiro Araki
- grid.256642.10000 0000 9269 4097Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-15, Showamachi, Maebashi, Gunma 371-8511 Japan
| | - Akira Watanabe
- grid.256642.10000 0000 9269 4097Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-15, Showamachi, Maebashi, Gunma 371-8511 Japan
| | - Norihiro Ishii
- grid.256642.10000 0000 9269 4097Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-15, Showamachi, Maebashi, Gunma 371-8511 Japan
| | - Kei Hagiwara
- grid.256642.10000 0000 9269 4097Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-15, Showamachi, Maebashi, Gunma 371-8511 Japan
| | - Kouki Hoshino
- grid.256642.10000 0000 9269 4097Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-15, Showamachi, Maebashi, Gunma 371-8511 Japan
| | - Ryo Muranushi
- grid.256642.10000 0000 9269 4097Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-15, Showamachi, Maebashi, Gunma 371-8511 Japan
| | - Satoru Kakizaki
- Department of Clinical Research, National Hospital Organization Takasaki General Medical Center, 36 Takamatsucho, Takasaki, Gunma 370-0829 Japan
| | - Yoshiyuki Ogawa
- grid.256642.10000 0000 9269 4097Department of Hematology, Graduate School of Medicine, Gunma University, 3-39-15, Showamachi, Maebashi, Gunma 371-8511 Japan
| | - Hiroshi Handa
- grid.256642.10000 0000 9269 4097Department of Hematology, Graduate School of Medicine, Gunma University, 3-39-15, Showamachi, Maebashi, Gunma 371-8511 Japan
| | - Ken Shirabe
- grid.256642.10000 0000 9269 4097Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-15, Showamachi, Maebashi, Gunma 371-8511 Japan
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Wiggins BT, Ramirez D, Taylor D, Reichardt W, Kipke A, Minaudo M. Medication-Induced Factor V Inhibition in the Setting of Refractory Coagulopathy. Hematol Rep 2022; 14:290-293. [PMID: 36278518 PMCID: PMC9590024 DOI: 10.3390/hematolrep14040041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/27/2022] [Accepted: 08/29/2022] [Indexed: 11/25/2022] Open
Abstract
Liver cirrhosis is commonly associated with coagulopathies, typically demonstrated by elevated prothrombin time, international normalized ratio, and partial thromboplastin time. In the setting of bleeding related to coagulopathies, oftentimes physicians try to reverse coagulopathy through a variety of methods including the use of vitamin K and fresh frozen plasma. Rarely, attempts at reversing coagulopathy are unsuccessful due to severe disease or factor inhibitors. The treatment of acquired factor V inhibitors is primarily performed through immunosuppression and supportive care for the initial bleeding episode. Early detection and treatment of factor V inhibition is challenging in a setting of underlying cirrhosis-related coagulopathy.
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Affiliation(s)
- Brandon Travis Wiggins
- Department of Internal Medicine, Ascension Genesys Hospital, Grand Blanc, MI 48439, USA
- Correspondence:
| | - Daniel Ramirez
- Division of Gastroenterology, Department of Internal Medicine, Ascension Genesys Hospital, Grand Blanc, MI 48439, USA
| | - Daniel Taylor
- Division of Hematology and Oncology, Department of Internal Medicine, Ascension Genesys Hospital, Grand Blanc, MI 48439, USA
| | - William Reichardt
- Division of Hematology and Oncology, Department of Internal Medicine, Ascension Genesys Hospital, Grand Blanc, MI 48439, USA
| | - Alyssa Kipke
- Division of Hematology and Oncology, Department of Internal Medicine, Ascension Genesys Hospital, Grand Blanc, MI 48439, USA
| | - Mark Minaudo
- Division of Gastroenterology, Department of Internal Medicine, Ascension Genesys Hospital, Grand Blanc, MI 48439, USA
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Factor V deficiency with a unique genetic mutation presenting as post-circumcision bleeding in a neonate, A-case-report. Ann Med Surg (Lond) 2022; 78:103723. [PMID: 35600191 PMCID: PMC9121243 DOI: 10.1016/j.amsu.2022.103723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/28/2022] [Accepted: 05/01/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction and importance Factor V deficiency is a rare bleeding disorder with varying presentations from minor mucosal bleeding to a life-threatening postoperative bleed. Currently, treatment is mainly supportive with Fresh Frozen Plasma. Case presentation A previously healthy 14-day-old male presented with an uncontrollable bleeding following a circumcision. Physical examination was normal. Investigations showed hemoglobin 15.5 g/dl, platelets 409000, Prothrombin Time 57 seconds, Partial-Thromboplastin-Time 120 seconds. Mixing study corrected the coagulation profile, and the factor assay showed factor V activity of 11%. Genetic testing showed a pathogenic frameshift mutation in the F5 gene p.(P927Lfs*7) causing premature termination after 7 codons thus the diagnosis of Factor V deficiency was made. Clinical discussion In this case, factor V deficiency presented as post-circumcision bleeding. For diagnosis, increased PT and PTT with normal thrombin time increases the index of suspicion for a bleeding disorder. Further testing with coagulation factors assays is required to make the final diagnosis. Factor V deficient patients undergoing surgery should be adequately prepared, and factor V activity level should be maintained at least at 25% of the normal activity level. The patient level prior to the circumcision was unknown, which led to the life threatening bleed. Conclusions One of the early presentations of factor V deficiency is a post-circumcision bleeding. Adequate preparation with laboratory tests before circumcision is therefore recommended, especially for high-risk individuals. More than 100 genetic mutations were detected; frameshift mutation involving F5 gene p.(P927Lfs*7) was seen in our case.
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8
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Biomaterials as Haemostatic Agents in Cardiovascular Surgery: Review of Current Situation and Future Trends. Polymers (Basel) 2022; 14:polym14061189. [PMID: 35335519 PMCID: PMC8955858 DOI: 10.3390/polym14061189] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 02/04/2023] Open
Abstract
Intraoperative haemostasis is of paramount importance in the practice of cardiovascular surgery. Over the past 70 years, topical haemostatic methods have advanced significantly and today we deal with various haemostatic agents with different properties and different mechanisms of action. The particularity of coagulation mechanisms after extracorporeal circulation, has encouraged the introduction of new types of topic agents to achieve haemostasis, where conventional methods prove their limits. These products have an important role in cardiac, as well as in vascular, surgery, mainly in major vascular procedures, like aortic dissections and aortic aneurysms. This article presents those agents used for topical application and the mechanism of haemostasis and offers general recommendations for their use in the operating room.
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9
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Kida W, Nakaya M, Ito A, Kozai Y, Bingo M. A Case of Acquired Factor V Inhibitor Following Nivolumab Administration. Cureus 2022; 14:e21670. [PMID: 35242461 PMCID: PMC8884452 DOI: 10.7759/cureus.21670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 11/08/2022] Open
Abstract
Acquired factor V inhibitor (AFVI) is a very rare disease. We presented herein a case of hypopharyngeal cancer in which AFVI developed after nivolumab administration. Blood test findings two weeks after the first dose of nivolumab showed a significant prolongation of prothrombin time (PT) and activated partial thromboplastin time (APTT), indicating a marked abnormality in the coagulation function. Factor V activity had decreased significantly and was below the detection limit (<3%), and the factor V inhibitor level was as high as 16 Bethesda units (BU)/mL. His underlying illness was a malignant tumor, but we considered that nivolumab administration was the cause of AFVI, considering the time when coagulation abnormality developed. No significant bleeding tendency was observed in the subsequent course, and the AFVI was followed up without treatment. To the best of our knowledge, the present study is the first to report AFVI occurrence after immune checkpoint inhibitor administration.
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Mima F, Minami R, Asako M, Matsunaga H, Fujita Y, Takimoto Y, Senda S, Nakahara W, Ikeda M, Ueda S. Acquired Factor V Inhibitor Complicated with Immune Thrombocytopenia. Intern Med 2022; 61:91-95. [PMID: 34176833 PMCID: PMC8810259 DOI: 10.2169/internalmedicine.7173-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We herein report a patient with a high bleeding tendency as a result of acquired factor V inhibitor and immune thrombocytopenia (ITP). The administration of prednisolone increased the platelet count, but a fatal bleeding event occurred before platelet levels had sufficiently increased. Factor V is stored in not only plasma but also platelets, and platelet-derived factor V might play a local hemostatic role. Bleeding tendency may be high in rare cases where factor V inhibitor is complicated with severe thrombocytopenia. In such patients, physicians should consider aggressive hemostatic therapy, including plasma exchange, in addition to immunosuppressive therapy.
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Affiliation(s)
- Fuka Mima
- Department of Hematology, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Ryota Minami
- Department of Hematology, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Mizuki Asako
- Department of Hematology, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Hitomi Matsunaga
- Department of Hematology, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Yuri Fujita
- Department of Clinical Laboratory, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Yoshimi Takimoto
- Department of Clinical Laboratory, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Sonoko Senda
- Department of Clinical Laboratory, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Wataru Nakahara
- Department of Hematology, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Mako Ikeda
- Department of Hematology, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Shuji Ueda
- Department of Hematology, Hyogo Prefectural Nishinomiya Hospital, Japan
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11
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Ichinose A, Osaki T, Souri M. A Review of Coagulation Abnormalities of Autoimmune Acquired Factor V Deficiency with a Focus on Japan. Semin Thromb Hemost 2021; 48:206-218. [PMID: 34942668 DOI: 10.1055/s-0041-1740149] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Coagulation factor V (or FV for the purpose of medical safety) is an essential cofactor of coagulation factor X in the common pathway of coagulation; severe FV deficiency leads to a bleeding tendency. Although both congenital and acquired FV deficiencies are widely recognized, FV deficiency also presents as an autoimmune disorder. A nationwide survey on autoimmune coagulation factor deficiencies (AiCFDs) conducted in Japan by our Japanese Collaborative Research Group identified 24 new patients with autoimmune FV deficiency (AiFVD) in the past 5 years. Furthermore, our extensive literature search confirmed that 177 AiFVD cases have been reported in previous articles published from Japan. Patients with AiFVD in Japan were predominantly men, with age similar to those with other AiCFDs. AiFVD was confirmed as a relatively mild type of bleeding diathesis, associated with lower mortality rate than that for AiFVD and other AiCFDs reported in previous studies. Patients with AiFVD had variable FV inhibitor titers and both neutralizing anti-FV autoantibodies and nonneutralizing counterparts. Although spontaneous resolution occurs in some patients, timely initiation of hemostatic and immunosuppressive therapies helps arrest the bleeding and eliminate anti-FV antibodies, resulting in a high cumulative recovery rate. Immunological anti-FV antibody detection is recommended to avoid missing AiFVD cases for the presence of nonneutralizing anti-FV autoantibodies. Further investigation is necessary to clarify the long-term prognosis and optimal management of AiFVD.
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Affiliation(s)
- Akitada Ichinose
- Department of Molecular Pathobiochemistry and Pathobiology, Yamagata University School of Medicine, Yamagata, Japan.,The Japanese Collaborative Research Group (JCRG) on Autoimmune Acquired Coagulation Factor Deficiencies supported by the Japanese Ministry of Health, Labor and Welfare (MHLW), Yamagata, Japan
| | - Tsukasa Osaki
- Department of Molecular Pathobiochemistry and Pathobiology, Yamagata University School of Medicine, Yamagata, Japan.,The Japanese Collaborative Research Group (JCRG) on Autoimmune Acquired Coagulation Factor Deficiencies supported by the Japanese Ministry of Health, Labor and Welfare (MHLW), Yamagata, Japan.,Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science, Iida-Nishi, Yamagata, Japan
| | - Masayoshi Souri
- Department of Molecular Pathobiochemistry and Pathobiology, Yamagata University School of Medicine, Yamagata, Japan.,The Japanese Collaborative Research Group (JCRG) on Autoimmune Acquired Coagulation Factor Deficiencies supported by the Japanese Ministry of Health, Labor and Welfare (MHLW), Yamagata, Japan.,Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science, Iida-Nishi, Yamagata, Japan
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12
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Chiurazzi F, Tufano A, Esposito M, D'Agostino F, Casoria A, Capasso F, Minno GD. Acquired Factor V Inhibitor after Coronavirus Disease 2019 (COVID-19). Semin Thromb Hemost 2021; 48:124-126. [PMID: 34560795 DOI: 10.1055/s-0041-1735452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Federico Chiurazzi
- Department of Hematology and Bone Marrow Transplantation, University of Naples "Federico II," Naples, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II," Naples, Italy
| | - Maria Esposito
- Department of Hematology and Bone Marrow Transplantation, University of Naples "Federico II," Naples, Italy
| | - Francesco D'Agostino
- Department of Hematology and Bone Marrow Transplantation, University of Naples "Federico II," Naples, Italy
| | - Aniello Casoria
- Department of Clinical Medicine and Surgery, University of Naples "Federico II," Naples, Italy
| | - Filomena Capasso
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II," Naples, Italy
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, University of Naples "Federico II," Naples, Italy
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13
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Yokota Y, Inatomi O, Nakagawa M, Kakuda K, Hiroe K, Sakai S, Osaki R, Iwasa M, Kawahara M, Kito K, Andoh A, Bamba H. Acquired Coagulation Factor V Inhibitor That Was Successfully Treated with Oral Corticosteroid Therapy. Intern Med 2021; 60:2663-2666. [PMID: 34121013 PMCID: PMC8429299 DOI: 10.2169/internalmedicine.7453-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Acquired coagulation factor V (FV) inhibitors are rare disorders in which antibodies against FV develop under various conditions. We herein report the case of a 71-year-old woman with FV inhibitor during radiochemotherapy for pancreatic cancer. Multiple purpuras suddenly appeared on her bilateral upper limbs with prolonged coagulation data (APTT 97.3 seconds). The FV activity was less than 3% and the FV inhibitor was positive (1.7 B.U./mL). Oral prednisolone induced a rapid normalization of the coagulation data and FV activity and a rapid disappearance of FV inhibitor within 7 days. Early diagnosis and treatment may therefore be important in cases of FV inhibitor.
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Affiliation(s)
- Yoshihiro Yokota
- Department of Gastroenterology, Nagahama Red Cross Hospital, Japan
| | - Osamu Inatomi
- Department of Medicine, Shiga University of Medical Science, Japan
| | - Minami Nakagawa
- Department of Clinical Laboratory Medicine, Nagahama Red Cross Hospital, Japan
| | - Kazuki Kakuda
- Department of Gastroenterology, Nagahama Red Cross Hospital, Japan
| | - Kousuke Hiroe
- Department of Gastroenterology, Nagahama Red Cross Hospital, Japan
| | - Shigeki Sakai
- Department of Gastroenterology, Nagahama Red Cross Hospital, Japan
| | - Rie Osaki
- Department of Gastroenterology, Nagahama Red Cross Hospital, Japan
| | - Masaki Iwasa
- Department of Medicine, Shiga University of Medical Science, Japan
| | | | - Katsuyuki Kito
- Department of Medicine, Shiga University of Medical Science, Japan
| | - Akira Andoh
- Department of Medicine, Shiga University of Medical Science, Japan
| | - Hiromichi Bamba
- Department of Gastroenterology, Nagahama Red Cross Hospital, Japan
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14
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Wada H, Ichinose A, Shiraki K, Shimpo H, Shimaoka M. Coagulation factor V inhibitors, a review of the case report literature. THROMBOSIS UPDATE 2021. [DOI: 10.1016/j.tru.2021.100058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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15
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Mao JY, Unnikrishnan B, Chu HW, Harroun SG, Chen YR, Wu AT, Chang HT, Lin HJ, Huang CC. Thermally driven formation of polyphenolic carbonized nanogels with high anticoagulant activity from polysaccharides. Biomater Sci 2021; 9:4679-4690. [PMID: 34018502 DOI: 10.1039/d1bm00402f] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We have demonstrated that alginate with negligible anticoagulant activity can be converted into carbonized nanogels with potent anticoagulant activity through a solid-state heating process. The conversion of alginate into graphene-like nanosheet (GNS)-embedded polyphenolic-alginate nanogels (GNS/Alg-NGs) has been carried out through condensation and carbonization processes. The GNS/Alg-NGs exhibit much stronger anticoagulant activity (>520-fold) compared to untreated alginate, mainly because their polyphenolic structures have a high binding affinity [dissociation constant (Kd) = 2.1 × 10-10 M] toward thrombin. In addition, the thrombin clotting time delay caused by the GNS/Alg-NGs is 10-fold longer than that of natural polyphenolic compounds, such as quercetin, catechin, naringenin, caffeic acid, and ferulic acid. The thrombin- or kaolin-activated thromboelastography of whole-blood coagulation reveals that the GNS/Alg-NGs display a much stronger anticoagulant ability than that of untreated alginate and naturally sulfated polysaccharides (fucoidan). The GNS/Alg-NGs exhibit superior biocompatibility and anticoagulant activity, as observed with an in vivo rat model, revealing their potential as a blood thinner for the treatment of thrombotic disorders.
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Affiliation(s)
- Ju-Yi Mao
- Department of Bioscience and Biotechnology, National Taiwan Ocean University, Keelung 20224, Taiwan. and Doctoral Degree Program in Marine Biotechnology, National Taiwan Ocean University, Keelung 20224, Taiwan and Doctoral Degree Program in Marine Biotechnology, Academia Sinica, Taipei 11529, Taiwan
| | - Binesh Unnikrishnan
- Department of Bioscience and Biotechnology, National Taiwan Ocean University, Keelung 20224, Taiwan.
| | - Han-Wei Chu
- Department of Bioscience and Biotechnology, National Taiwan Ocean University, Keelung 20224, Taiwan.
| | - Scott G Harroun
- Department of Chemistry, Université de Montréal, Montréal, Québec H3C 3J7, Canada
| | - Yet-Ran Chen
- Agricultural Biotechnology Research Center, Academia Sinica, Taipei 11529, Taiwan
| | - An-Tai Wu
- Department of Chemistry, National Changhua University of Education, Changhua 50058, Taiwan
| | - Huan-Tsung Chang
- Department of Chemistry, National Taiwan University, Taipei 10617, Taiwan
| | - Han-Jia Lin
- Department of Bioscience and Biotechnology, National Taiwan Ocean University, Keelung 20224, Taiwan. and Center of Excellence for the Oceans, National Taiwan Ocean University, Keelung 20224, Taiwan
| | - Chih-Ching Huang
- Department of Bioscience and Biotechnology, National Taiwan Ocean University, Keelung 20224, Taiwan. and Center of Excellence for the Oceans, National Taiwan Ocean University, Keelung 20224, Taiwan and School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
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16
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Fortuna GMG, Guerra V, Chaaya G. Acquired factor V inhibitor presenting as life threatening bleeding after initiation of apixaban. Haemophilia 2021; 27:e636-e637. [PMID: 34171151 DOI: 10.1111/hae.14374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Veronica Guerra
- Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Gerard Chaaya
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, Florida, USA
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17
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Kamatani K, Kenzaka T, Sugimoto R, Kumabe A, Kitao A, Akita H. Multiple thrombosis associated with Cytomegalovirus enterocolitis in an immunocompetent patient: a case report. BMC Infect Dis 2021; 21:530. [PMID: 34090366 PMCID: PMC8180152 DOI: 10.1186/s12879-021-06230-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/24/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) is reported to have thrombogenic characteristics that activate factor X in vitro and stimulate the production of factor VIII and von Willebrand factor (vWF). Thrombosis associated with CMV infection is prevalent among immunocompromised patients and predominantly presents as a solitary large thrombus in the deep vein, pulmonary artery, splanchnic arteriovenous ducts, or other similar sites. Multiple thrombi, however, are rarely observed in such cases. Here, we report about an immunocompetent man with multiple microthrombi associated with CMV infection. CASE PRESENTATION A 72-year-old Japanese man who complained of abdominal pain was hospitalized with multiple colonic stenosis. He was later diagnosed with CMV enterocolitis and treated with ganciclover from Day 27 post-admission. During hospitalization, the patient developed thrombi in his fingers. He was initially treated with anticoagulant therapy (rivaroxaban); however, the therapy was discontinued owing to a prolonged activated thromboplastin time and an elevated international normalized ratio of prothrombin time. Instead, vitamin K and fresh-frozen plasma were administered. Nevertheless, his coagulation profile remained abnormal. Eventually, he developed colonic perforation and had to undergo emergency surgery. An intraoperative specimen showed several microthrombi in the middle and small arteriovenous ducts of his small and large intestines. The patient's coagulopathy improved preoperatively, and his overall condition improved postoperatively. Since the activation of ADAMTS13 was reduced remarkably, the thrombotic tendency was determined to be a thrombotic microangiopathy-like condition owing to increased vWF. We could not attribute the coagulopathy to any other cause except CMV infection; therefore, we concluded that this was a case of multiple thrombosis associated with CMV. CONCLUSIONS We present an extremely rare case of a patient with multiple thrombotic microangiopathy-like microthrombosis caused by CMV infection. Our findings suggest that CMV infection may be considered as a differential diagnosis for immunocompetent individuals who present with thrombosis of unspecified cause.
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Affiliation(s)
- Kaisei Kamatani
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7 Iso, Hikami-cho, Tamba, 669-3495, Japan
| | - Tsuneaki Kenzaka
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7 Iso, Hikami-cho, Tamba, 669-3495, Japan.
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, 2-1-5, Arata-cho, Hyogo-ku, Kobe, Hyogo, 652-0032, Japan.
| | - Ryu Sugimoto
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7 Iso, Hikami-cho, Tamba, 669-3495, Japan
| | - Ayako Kumabe
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, 2-1-5, Arata-cho, Hyogo-ku, Kobe, Hyogo, 652-0032, Japan
- Department of General Medicine, Toyooka Public Hospital, 1094, Tobera, Toyooka, Hyogo, 668-8501, Japan
| | - Akihito Kitao
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Hozuka Akita
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7 Iso, Hikami-cho, Tamba, 669-3495, Japan
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18
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Bennett J, Cunningham MT, Howard C, Hoffmann M, Plapp FV. Acquired factor V inhibitor in the setting of coronavirus disease 2019 infection. Blood Coagul Fibrinolysis 2021; 32:294-297. [PMID: 33443928 DOI: 10.1097/mbc.0000000000001009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Factor V inhibitors are a rare cause of life-threatening bleeding. We present a case of an acquired factor V inhibitor likely caused by coronavirus disease 2019 infection. Bleeding was manifested by severe anemia requiring frequent red-cell transfusion, left psoas muscle hematoma, and left retroperitoneal cavity hematoma. Factor V activity was less than 1% and the factor V inhibitor titer was 31.6 Bethesda units. Severe acute respiratory syndrome coronavirus 2 RNA testing of the nasopharynx was positive 2 weeks before presentation and continued to be positive for 30 days. The patient failed treatment with intravenous immunoglobulin and dexamethasone. Three cycles of plasmapheresis with fresh frozen plasma replacement resulted in correction of the bleeding and laboratory coagulopathy. This is the first reported case of a factor V inhibitor in a coronavirus disease 2019 patient and suggests that plasmapheresis may be a successful treatment strategy.
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Affiliation(s)
| | | | - Christin Howard
- Department of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Marc Hoffmann
- Department of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, Kansas, USA
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19
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Pineau-Vincent F, Toulon P, Lemaire P, Laribi K. Acquired factor V inhibitor: Success of steroids in a patient with primary sclerosing cholangitis, ulcero haemorragic rectocolitis, biological Biermer's disease. Transfus Clin Biol 2021; 28:191-193. [PMID: 33516887 DOI: 10.1016/j.tracli.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 01/14/2021] [Accepted: 01/20/2021] [Indexed: 11/15/2022]
Abstract
We report the case of a 43-years-old Turkish man with acquired deficiency of factor V (FV) diagnosed in a usual screening before a (recto) colonoscopy. In the biologic explorations, activated partial prothrombin time (APTT) was abnormally high and prothrombin time (PT) was low 18IU/dL with no anticoagulant drugs (the PT was normal 6 months ago). The controlled level of factor V was 3IU/dL with FV antibodies (9 Bethesda Units/mL). This patient had a previous history of primary sclerosing cholangitis (2000) and ulcero haemorrhagic rectocolitis (2002) and a fortuitous biological Biermer's disease was revealed. Corticosteroids were prescribed at 1mg/kg/day with decreasing during 6 months, patient had gradual regression of the caused bleeding and FV became greater than 90%, F V antibodies decreased to less than 0.7 Bethesda Units/mL. This case illustrates the presence of FV inhibitor in an autoimmune gastrointestinal context with regression of clinical (caused) signs and antibodies with corticosteroids.
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Affiliation(s)
| | - P Toulon
- Hemostasis, CHU de Nice, Nice, France.
| | - P Lemaire
- Hemostasis, centre hospitalier Le Mans, Le Mans, France.
| | - K Laribi
- Hematology, centre hospitalier Le Mans, Le Mans, France.
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20
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Giuffrida G, Markovic U, Nicolosi D, Calafiore V. A rare case of acquired factor V inhibitor, during treatment with dabigatran for chronic atrial fibrillation, successfully treated with bypassing agents. Clin Case Rep 2021; 9:623-628. [PMID: 33598214 PMCID: PMC7869404 DOI: 10.1002/ccr3.3586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/26/2020] [Accepted: 09/24/2020] [Indexed: 11/19/2022] Open
Abstract
Acquired factor V inhibitor represents a rare condition, described only in case reports. The use of activated bypassing agents in bleeding control could be of aid and improve the survival in symptomatic patients with acquired factor V inhibitor.
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Affiliation(s)
- Gaetano Giuffrida
- Division of HematologyAOU “Policlinico ‐ Vittorio Emanuele”CataniaItaly
- Department of General Surgery and Medical‐Surgical Specialties, Hematology SectionUniversity of CataniaCataniaItaly
| | - Uros Markovic
- Division of HematologyAOU “Policlinico ‐ Vittorio Emanuele”CataniaItaly
- Department of General Surgery and Medical‐Surgical Specialties, Hematology SectionUniversity of CataniaCataniaItaly
| | - Daniela Nicolosi
- Division of HematologyAOU “Policlinico ‐ Vittorio Emanuele”CataniaItaly
- Department of General Surgery and Medical‐Surgical Specialties, Hematology SectionUniversity of CataniaCataniaItaly
| | - Valeria Calafiore
- Division of HematologyAOU “Policlinico ‐ Vittorio Emanuele”CataniaItaly
- Department of General Surgery and Medical‐Surgical Specialties, Hematology SectionUniversity of CataniaCataniaItaly
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21
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Autoimmune Factor V Deficiency That Took 16 Years to Diagnose due to Pseudodeficiency of Multiple Coagulation Factors. Case Rep Med 2021; 2021:4657501. [PMID: 33505468 PMCID: PMC7815411 DOI: 10.1155/2021/4657501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 12/06/2020] [Accepted: 01/02/2021] [Indexed: 11/18/2022] Open
Abstract
A 70-year-old man presented to our hospital with intramuscular hemorrhage in the right thigh. He had exhibited a tendency to bleed for the last 16 years and had visited several medical institutions, but no diagnosis had been made. Since the risk of sudden bleeding was assumed to be high due to his age, we decided to examine him in our department. A coagulation abnormality with prothrombin time-international normalized ratio (PT-INR) of 4.5 and activated partial thromboplastin time (aPTT) of 99.6 seconds was observed, but the platelet count, fibrinogen, and PIVKAII were within normal limits. Coagulation activities of factor V, VII, VIII, IX, X, XI, XII, and XIII were all reduced. Anti-factor VIII and IX antibodies which were measured by the Bethesda method, lupus anti-coagulant (diluted Russell snake venom time method) and anti-cardiolipin antibody were also positive. The results of these tests were comparable to those undertaken 15 years ago when they were scrutinized at the university hospital. We suspected the presence of anti-factor V antibodies because there was a dissociation between the thrombotest values measured and those calculated from the PT-INR. Moreover, cross-mixing test showed an immediate inhibitor pattern. Subsequently, factor V antibodies were confirmed by the immunoblot method and the diagnosis of autoimmune factor V deficiency was made. When factor V, which is downstream of the coagulation cascade, is inhibited, coagulation test using the one-stage clotting method shows a pseudolow value. Therefore, extensive abnormalities of coagulation factor activity and inhibitor assay should be interpreted with caution, and the presence of a high titer of factor V inhibitor should be considered.
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22
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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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23
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Hirata H, Sakurai Y, Takeda T, Kasetani T, Morita T. Development of Acquired Factor V Inhibitor After Surgical Procedure Without the Use of Fibrin Tissue Adhesives: A Case Report. Cureus 2021; 13:e12708. [PMID: 33489635 PMCID: PMC7813542 DOI: 10.7759/cureus.12708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Development of acquired factor V (FV) inhibitor is a rare coagulation disorder. Production of heteroantibodies against bovine FV, a contaminant in fibrin tissue adhesives, is a common cause of this condition in the field of surgery. The development of recombinant thrombin eliminated contamination of bovine FV, and infrequent use of bovine thrombin has decreased the risk of FV inhibitor development. Here, we report the case of a 43-year-old man who had marked prolongation of prothrombin time and activated partial thromboplastin time after surgery. Mixing coagulation studies with normal plasma and patient’s plasma suggested the presence of an inhibitor. Clotting factor assays revealed that FV activity decreased to <1% with positive FV inhibitor titer (9.2 Bethesda units). The diagnosis of the FV inhibitor was confirmed. Overt bleeding was not observed during the course of hospitalization. His coagulation abnormalities rapidly normalized without any medical intervention. A careful review of his medical records revealed that no tissue adhesives were used in the patient, and the FV inhibitor would likely be autoantibodies. Antibiotic use during the perioperative period or the surgical procedure itself may trigger the occurrence of FV inhibitors. This case highlights that FV inhibitor may develop after the surgical procedure even without a history of the use of fibrin tissue adhesives. Surgeons and hematologists should be aware that this rare but potentially life-threatening condition may occur after the surgical procedure.
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Affiliation(s)
- Hirohisa Hirata
- Department of Surgery, Matsubara Tokushukai Hospital, Matsubara, JPN
| | - Yoshihiko Sakurai
- Department of Pediatrics, Matsubara Tokushukai Hospital, Matsubara, JPN
| | - Tomohiro Takeda
- Department of Clinical Laboratory Science, Kansai University of Health Sciences, Kumatori-cho, JPN
| | - Tetsuya Kasetani
- Department of Surgery, Matsubara Tokushukai Hospital, Matsubara, JPN
| | - Takeshi Morita
- Department of Surgery, Matsubara Tokushukai Hospital, Matsubara, JPN
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24
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Bruna R, Moia R, Valpreda A, Dosio E, Rolla R, Federici A, Dianzani U, Gaidano G, Patriarca A. An acquired factor V inhibitor induced uncontrolled bleeding in a postsurgery patient. Clin Case Rep 2021; 9:98-101. [PMID: 33489140 PMCID: PMC7813060 DOI: 10.1002/ccr3.3452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/20/2020] [Accepted: 09/24/2020] [Indexed: 11/10/2022] Open
Abstract
This case report highlights the challenges in controlling bleeding and correcting coagulation tests through the use of bypassing agents in patients with FV inhibitors.
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Affiliation(s)
- Riccardo Bruna
- Division of HematologyDepartment of Translational MedicineUniversità del Piemonte OrientaleNovaraItaly
| | - Riccardo Moia
- Division of HematologyDepartment of Translational MedicineUniversità del Piemonte OrientaleNovaraItaly
| | - Alessandra Valpreda
- Regional Center for Hemorrhagic and Thrombotic Diseases Haematology Laboratory City of Health and Science University Hospital of MolinetteTurinItaly
| | - Enrico Dosio
- Regional Center for Hemorrhagic and Thrombotic Diseases Haematology Laboratory City of Health and Science University Hospital of MolinetteTurinItaly
| | - Roberta Rolla
- Department of Health Sciences and Interdisciplinary Research Center of Autoimmune Diseases (IRCAD)Università del Piemonte OrientaleNovaraItaly
| | - Augusto Federici
- Department of Oncology and OncohematologyHematology and Transfusion MedicineL. Sacco University HospitalUniversity of MilanMilanoItaly
| | - Umberto Dianzani
- Department of Health Sciences and Interdisciplinary Research Center of Autoimmune Diseases (IRCAD)Università del Piemonte OrientaleNovaraItaly
| | - Gianluca Gaidano
- Division of HematologyDepartment of Translational MedicineUniversità del Piemonte OrientaleNovaraItaly
| | - Andrea Patriarca
- Division of HematologyDepartment of Translational MedicineUniversità del Piemonte OrientaleNovaraItaly
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25
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Wu AH, Manje Gowda A, Peng S, Kaur S, Maroules M. Successful Management of Life-threatening Pelvic Hemorrhage From Acquired Factor V Deficiency With immunosuppressive Therapy. Cureus 2020; 12:e9972. [PMID: 32983675 PMCID: PMC7510508 DOI: 10.7759/cureus.9972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Acquired Factor V deficiency is a rare and challenging condition to treat. It has been associated with major surgeries, antibiotics, blood transfusions, infections, autoimmune disorders, malignancy and exposure to bovine thrombin. The clinical presentation can be heterogeneous and can manifest as asymptomatic laboratory abnormalities to fatal hemorrhage with mortality rates around 15-20% . We report a case of acquired factor V deficiency in which the patient developed a life-threatening bleeding coagulopathy with elevated prothrombin time, activated partial thromboplastin time and factor V inhibitor titers following multiple surgical procedures that were performed after a motor vehicle accident. The patient was successfully treated with immunosuppressive therapy including steroids and cyclophosphamide resulting in the complete elimination of inhibitor levels.
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26
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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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27
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Chartier AR, Hillert CJ, Gill H, Jha P. Acquired Factor V Inhibitor After Antibiotic Therapy: A Clinical Case Report and Review of the Literature. Cureus 2020; 12:e9481. [PMID: 32874809 PMCID: PMC7455466 DOI: 10.7759/cureus.9481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Acquired factor V inhibitor (aFVi) is an exceptionally rare hematologic condition that can range from incidental laboratory abnormalities to life-threatening hemorrhage. Bovine thrombin was formerly the most common cause of this condition; however, the decreased use of bovine thrombin in surgical procedures has led to a shift in the cause of aFVi toward antibiotic use and malignancies. Here we present a case of an 80-year-old Caucasian female on long-term warfarin therapy who presented with epistaxis and an elevated international normalized ratio, and a history of cephalosporin antibiotic use. We review the published literature beginning in 2016 to identify the evolving causes of aFVi. Additionally, we propose that stress-mediated immune regulation may contribute to antibody formation, preventing the interaction between factor V and the damaged phospholipid membranes. This case highlights the evolving causes of aFVi and should prompt physicians to consider this diagnosis in coagulopathies that do not correct with traditional therapies.
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28
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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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29
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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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30
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Menegatti M, Biguzzi E, Peyvandi F. Management of rare acquired bleeding disorders. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:80-87. [PMID: 31808848 PMCID: PMC6913473 DOI: 10.1182/hematology.2019000066] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Autoantibodies toward clotting factors may develop in people suffering from autoimmune or neoplastic diseases, after drug intake or even in subjects without apparent conditions. They are more commonly directed against factor VIII (FVIII) or von Willebrand factor leading to acquired hemophilia A or acquired von Willebrand syndrome, respectively. Rarely, autoantibodies develop against other clotting factors, such as fibrinogen, FII, FV, FVII, FX, FXI, and FXIII. The clinical picture of an acquired bleeding disorder includes a wide spectrum of clinical manifestations ranging from minimal or no bleeding to life-threatening events. Patients with no previous personal or family history of bleeding may have sudden-onset hemorrhagic manifestations, sometimes fatal, especially if an early diagnosis is not made. On the other hand, some patients may not have hemorrhagic symptoms at onset, and their diagnosis can therefore be delayed. The laboratory diagnostic assessment is performed by screening coagulation tests followed by specific factor-level measurement and inhibitor-titrating assays. An early diagnosis of acquired coagulopathies is mandatory for starting the appropriate treatment aimed at both controlling the acute bleeding episode mainly using the bypassing agents, and eradicating the anticlotting factor autoantibody, using immunosuppressive treatment. Therefore, prompt intervention by an expert and a specialized center is needed for immediate recognition and treatment of the disease.
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Affiliation(s)
- Marzia Menegatti
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy; and
| | - Eugenia Biguzzi
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy; and
| | - Flora Peyvandi
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy; and
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Mihara M, Ogawa Y, Nagasaka M, Kobayashi N, Shimizu H, Shinozawa K, Fukutake K, Inoue M, Murakami M, Handa H. Successful Management of Acquired Factor V Inhibitor by Monitoring Factor V Activity, Antigen, and Inhibitor Values during Immunosuppressive Therapy. Acta Haematol 2019; 143:486-490. [PMID: 31563916 DOI: 10.1159/000502730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 08/15/2019] [Indexed: 11/19/2022]
Abstract
Acquired factor V inhibitor (AFVI) results from the formation of autoantibodies to coagulation factor V (FV), and the clinical phenotype can range from asymptomatic laboratory abnormalities to life-threatening bleeds. We describe a 74-year-old man who developed AFVI along with a massive subcutaneous hematoma. He was initially treated with prednisolone (PSL), but AFVI recurred when the dose was reduced after a short period. We subsequently increased the PSL dose and added cyclophosphamide (CY), which resulted in a complete response. We then gradually tapered PSL and stopped CY, and the patient has since remained free of recurrent AFVI symptoms. We monitored FV activity, antigen concentrations, and inhibitor titers of this patient throughout the clinical course. The ratio of FV activity to antigen concentration was low at diagnosis and gradually increased along with the patient's improvement. This ratio might be a useful parameter for evaluating the effects of immunosuppressive therapy in patients with AFVI.
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Affiliation(s)
- Masahiro Mihara
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
- Department of Internal Medicine, Kiboukan Hospital, Takasaki, Japan
| | - Yoshiyuki Ogawa
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan,
| | - Motoo Nagasaka
- Department of Internal Medicine, Kiboukan Hospital, Takasaki, Japan
| | - Nobuhiko Kobayashi
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroaki Shimizu
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
- Department of Internal Medicine, Kiboukan Hospital, Takasaki, Japan
| | - Keiko Shinozawa
- Department of Molecular Genetics of Coagulation Disorders, Tokyo Medical University, Tokyo, Japan
| | - Katsuyuki Fukutake
- Department of Molecular Genetics of Coagulation Disorders, Tokyo Medical University, Tokyo, Japan
- Department of Laboratory Medicine, Tokyo Medical University, Tokyo, Japan
| | - Madoka Inoue
- Department of Clinical Laboratory, Gunma University Hospital, Maebashi, Japan
| | - Masami Murakami
- Department of Clinical Laboratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroshi Handa
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
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Sakatoku K, Takakuwa T, Miura A, Araki T, Fujitani Y, Yamamura R. Acquired Factor V Inhibitor with Hemorrhagic Symptoms after Prasugrel Hydrochloride Treatment. Acta Haematol 2019; 143:478-480. [PMID: 31522179 DOI: 10.1159/000502406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/29/2019] [Indexed: 11/19/2022]
Abstract
Acquired factor V inhibitor (AFVI) is a rare coagulopathy. It may be triggered by specific antigens such as antibiotics. We herein report the first case of AFVI after treatment with prasugrel hydrochloride (prasugrel) in an 80-year-old male who underwent percutaneous coronary intervention because of angina pectoris 6 years ago and was initiated on aspirin and ticlopidine hydrochloride. He was switched from ticlopidine hydrochloride to prasugrel before undergoing percutaneous coronary intervention for myocardial infarction. Fifteen days later, he developed sudden nasal hemorrhage, hematuria, and systemic purpura. Coagulation tests revealed prolonged prothrombin time-international normalized ratio (11.35) and activated partial thromboplastin time (170 s). The coagulation factor profile revealed a decreased FV activity (1%). The Bethesda assay for FV inhibitor was positive. AFVI was diagnosed; prasugrel was immediately discontinued, and administration of recombinant activated factor VII and prednisolone were initiated. Hemorrhagic symptoms immediately disappeared; FV activity improved, and the FV inhibitor titer was normalized.
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Affiliation(s)
- Kazuki Sakatoku
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan,
- Department of Hematology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan,
| | - Teruhito Takakuwa
- Department of Hematology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Akiko Miura
- Department of Hematology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Taku Araki
- Department of Hematology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Yotaro Fujitani
- Department of Hematology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Ryosuke Yamamura
- Department of Hematology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
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33
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Lim MY, Greenberg CS. Importance of platelet activation in the regulation of whole blood coagulation in the presence of a factor V inhibitor. Haemophilia 2019; 25:e307-e310. [PMID: 31140208 DOI: 10.1111/hae.13782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/09/2019] [Accepted: 05/09/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Ming Y Lim
- Department of Medicine, Division of Hematology/Oncology, Medical University of South Carolina, Charleston, South Carolina
| | - Charles S Greenberg
- Department of Medicine, Division of Hematology/Oncology, Medical University of South Carolina, Charleston, South Carolina
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34
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Hoffmann C, Amiral J, Rezig S, Kerspern H, Jantzem H, Robin S, Collins A, Mornet C, Mingant F, Pan Petesch B, Ianotto JC, Lippert E, Galinat H. A very potent factor V inhibitor interferes with the levels of all coagulation factors and causes a fatal hemorrhagic syndrome. Eur J Haematol 2019; 103:137-139. [PMID: 31102471 DOI: 10.1111/ejh.13249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 12/01/2022]
Abstract
We report a very high factor V inhibitor affecting the measurement of all coagulation factors besides fibrinogen, all these factors being dramatically decreased. This inhibitor could be linked to antibiotic use. The patient died of massive hemorrhage before a plasma exchange could be initiated.
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Affiliation(s)
| | | | | | | | | | - Sara Robin
- CHRU Brest - Service de Médecine Interne, Brest, France
| | - Adam Collins
- CHRU Brest - Laboratoire d'Hématologie, Brest, France
| | - Clelia Mornet
- CHRU Brest - Laboratoire d'Hématologie, Brest, France
| | - Fanny Mingant
- CHRU Brest - Laboratoire d'Hématologie, Brest, France
| | | | | | - Eric Lippert
- CHRU Brest - Laboratoire d'Hématologie, Brest, France.,Univ Brest, Inserm, EFS, UMR 1078, GGB, Brest, France
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Mouton C, Leroux L, Bonnet G, Seguy B, Lafargue A, Baulier G, Castet S, Fiore M. Successful management of transcatheter aortic valve implantation by platelet transfusions in a nonagenarian patient with severe autoimmune factor V deficiency. Ann Hematol 2019; 98:1991-1992. [PMID: 30830247 DOI: 10.1007/s00277-019-03646-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/25/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Christine Mouton
- Laboratoire d'hématologie, Hôpital cardiologique, Centre Hospitalo-Universitaire de Bordeaux, Pessac, France
| | - Lionel Leroux
- Service de cardiologie interventionnelle, Hôpital cardiologique, Centre Hospitalo-Universitaire de Bordeaux, Pessac, France
| | - Guillaume Bonnet
- Service de cardiologie interventionnelle, Hôpital cardiologique, Centre Hospitalo-Universitaire de Bordeaux, Pessac, France
| | - Benjamin Seguy
- Unité de de Soins Intensifs et Continus de Cardiologie, Hôpital cardiologique, Centre Hospitalo-Universitaire de Bordeaux, Pessac, France
| | - Aurélie Lafargue
- Unité mobile de gériatrie, Hôpital Saint-André, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France
| | - Gildas Baulier
- Service de médecine interne et immunologie clinique, Hôpital Saint-André, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France
| | - Sabine Castet
- Centre de Ressources et de Compétences des Maladies Hémorragiques Constitutionnelles, Hôpital Pellegrin, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France
| | - Mathieu Fiore
- Centre de Référence des Pathologies Plaquettaires Constitutionnelles, Hôpital cardiologique, Centre Hospitalo-Universitaire de Bordeaux, Pessac, France. .,Laboratoire d'Hématologie, Hôpital Cardiologique, Avenue Magellan, 33604, Pessac, France.
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36
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Li F, Shu K, Liu J, Shen C, Wang X, Zhang Z, Jiang M. Acquired Factor V Inhibitor with Symptoms and Titer of Inhibitor Differences: Report of Two Cases. Acta Haematol 2019; 141:148-150. [PMID: 30783058 DOI: 10.1159/000496080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 12/07/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Fanfan Li
- Clinical Laboratory Center, The second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kuangyi Shu
- Clinical Laboratory Center, The second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jie Liu
- Clinical Laboratory Center, The second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chenfang Shen
- Clinical Laboratory Center, The second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoou Wang
- Clinical Laboratory Center, The second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhaohua Zhang
- Clinical Laboratory Center, The second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Minghua Jiang
- Clinical Laboratory Center, The second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China,
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Sakuraoka Y, Suzuki T, Mtsumoto T, Tanaka G, Shimizu T, Shiraki T, Kyongha P, Mori S, Iso Y, Kato M, Aoki T, Kubota K. Dramatic decreases of all haemorrhagic coagulation factors by acquired inhibitors after extended left lobectomy. Int J Surg Case Rep 2019; 55:140-144. [PMID: 30731301 PMCID: PMC6365396 DOI: 10.1016/j.ijscr.2019.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/16/2019] [Accepted: 01/22/2019] [Indexed: 11/26/2022] Open
Abstract
Required inhibitors of all coagulation factors. After liver resection. Severe bleeding. Benefits of using steroid.
Introduction Acquired inhibition of coagulation factors is a rare disease, and the diagnosis is often difficult and delayed. We experienced a deficiency in all coagulation factors after hepatobiliary surgery. Case Presentation Extended left liver resection was undertaken and hepaticojejunostomy was performed in a 70-year-old man. He had suffered from a high fever caused by cholangitis for 35 days. The major cause was a narrowing of the hepaticojejunostomy, and reconstruction was carried out. Twenty-four days later, there was a sudden massive bleed from his nose and the surgical site. Steroid pulse therapy was used as a treatment because cross mixing and some blood tests revealed the patient was experiencing an inhibition of all coagulation factors, and consequently the levels of coagulation factors dramatically recovered. Discussion We considered malignancy and surgical damages to be the underlying cause. The reported treatment and examination will help clinicians explore additional reasons for massive bleeding after a severe physical injury. Conclusion We have described the first case of acquired inhibition of all coagulation factors associated with extended left lobectomy.
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Affiliation(s)
- Yuhki Sakuraoka
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan.
| | - Takashi Suzuki
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
| | - Takatsugu Mtsumoto
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
| | - Genki Tanaka
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
| | - Takayuki Shimizu
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
| | - Takayuki Shiraki
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
| | - Park Kyongha
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
| | - Shozo Mori
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
| | - Yukihiro Iso
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
| | - Masato Kato
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
| | - Taku Aoki
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
| | - Keiichi Kubota
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
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38
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Harrold IM, Oladipo O. Elevated PT and aPTT. Clin Chem 2018; 64:1790-1791. [PMID: 30487193 DOI: 10.1373/clinchem.2018.290361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/30/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Ian M Harrold
- Department of Pathology and Laboratory Medicine, Penn State Health Hershey Medical Center, Hershey, PA.
| | - Olajumoke Oladipo
- Department of Pathology and Laboratory Medicine, Penn State Health Hershey Medical Center, Hershey, PA
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39
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Sridharan M, Fylling KA, Ashrani AA, Chen D, Marshall AL, Hook CC, Cardel LK, Nichols WL, Pruthi RK. Clinical and laboratory diagnosis of autoimmune factor V inhibitors: A single institutional experience. Thromb Res 2018; 171:14-21. [DOI: 10.1016/j.thromres.2018.09.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/22/2018] [Accepted: 09/04/2018] [Indexed: 12/17/2022]
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40
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Mitsuhashi T, Takamiya O. Acquired factor V inhibitor-related severe bleeding due to unformed prothrombinase complex. Thromb Res 2018; 171:81-83. [PMID: 30267973 DOI: 10.1016/j.thromres.2018.09.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Tomoko Mitsuhashi
- National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan.
| | - Osamu Takamiya
- Nagahama Institute of Bio-Science and Technology, Shiga, Japan.
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41
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Farhat E, Tegg E, Mohammed S, Grzechnik E, Favaloro EJ. Not as sweet as honey: A rare case of an apparent factor V "inhibitor" in association with bee sting anaphylaxis. Am J Hematol 2018; 93:965-970. [PMID: 29675861 DOI: 10.1002/ajh.25121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/10/2018] [Accepted: 04/17/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Elisabeth Farhat
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital; Westmead NSW Australia
| | - Elizabeth Tegg
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital; Westmead NSW Australia
| | - Soma Mohammed
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital; Westmead NSW Australia
| | - Elzbieta Grzechnik
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital; Westmead NSW Australia
| | - Emmanuel J. Favaloro
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital; Westmead NSW Australia
- Sydney Centres for Thrombosis and Haemostasis; Westmead NSW Australia
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42
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Fujita Y, Nakazato T, Ito C, Masuda K, Osada Y, Aisa Y, Mori T. A rare case of an acquired factor V inhibitor in a patient with myelodysplastic syndrome during azacitidine treatment. Ann Hematol 2018; 97:2009-2010. [PMID: 29713749 DOI: 10.1007/s00277-018-3348-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 04/23/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Yuriko Fujita
- Department of Hematology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-8555, Japan
| | - Tomonori Nakazato
- Department of Hematology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-8555, Japan.
| | - Chisako Ito
- Department of Hematology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-8555, Japan
| | - Kyoko Masuda
- Department of Hematology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-8555, Japan
| | - Yuki Osada
- Department of Hematology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-8555, Japan
| | - Yoshinobu Aisa
- Department of Hematology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-8555, Japan
| | - Takehiko Mori
- Division of Hematology, Keio University School of Medicine, Tokyo, Japan
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43
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De Maertelaere E, Castoldi E, Van Haute I, Deeren D, Devreese KM. The interaction of factor V and tissue factor pathway inhibitor in a myeloma patient with acquired factor V deficiency. Haemophilia 2018; 24:e160-e163. [PMID: 29665188 DOI: 10.1111/hae.13492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - E Castoldi
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - I Van Haute
- Clinical Laboratory, AZ Delta Hospital, Roeselare, Belgium
| | - D Deeren
- Clinical Haematology, AZ Delta Hospital, Roeselare, Belgium
| | - K M Devreese
- Coagulation Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital, Ghent, Belgium
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44
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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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45
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Acquired factor V deficiency in a patient with a urinary tract infection presenting with haematuria followed by multiple haemorrhages with an extremely low level of factor V inhibitor: a case report and review of the literature. Blood Coagul Fibrinolysis 2018; 28:334-341. [PMID: 27428013 PMCID: PMC5432097 DOI: 10.1097/mbc.0000000000000581] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
: Acquired factor V deficiency (AFVD) is a rare haemostatic disorder that is primarily because of the development of factor V inhibitors. Approximately, 200 cases have been reported and the greatest portion of these cases was because of bovine thrombin exposure. We report a case of a man who presented with haematuria followed by multiple haemorrhages associated with an elevated prothrombin time and an activated partial thromboplastin time. A workup revealed reduced factor V activity and a factor V inhibitor level of 1.9 BU, which were likely secondary to a urinary tract infection. Using corticosteroids, we successfully eliminated the inhibitor and controlled the bleeding. We review the published literature to identify the conditions that are associated with nonbovine thrombin AFVD. We assume that AFVD should be kept in mind for patients who present with multiple haemorrhages.
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Nakata K, Ueda S, Matsunaga H, Mima F, Ueda H, Yoshioka A, Kaneko S, Maruo K, Morris S, Yonemoto S, Hayashi D, Fujii N, Narahara H, Inui Y, Kawata S. High Titer of Acquired Factor V Inhibitor Presenting with a Pseudo-deficiency of Multiple Coagulation Factors. Intern Med 2018; 57:393-397. [PMID: 29093398 PMCID: PMC5827322 DOI: 10.2169/internalmedicine.9150-17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Acquired coagulation factor inhibitor is a rare coagulation disorder. We herein report a patient with acquired factor V inhibitor showing a decrease in multiple coagulation factor activities. A high titer of factor V inhibitor presumably led to a marked inhibition of factor V activity in the specific factor-deficient plasma used in coagulation factor activity assays based on either an activated partial thromboplastin time (APTT) or prothrombin time (PT) clotting assay, resulting in false low values of the coagulation activity. We re-examined the coagulation factor activity using several dilutions of the patient's plasma and confirmed that the high factor V inhibitor titer had caused an apparent decrease in multiple coagulation factor activities.
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Affiliation(s)
- Keiichi Nakata
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Shuji Ueda
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Hitomi Matsunaga
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Fuka Mima
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Hiroki Ueda
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Aya Yoshioka
- Department of Clinical Laboratory, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Sayoko Kaneko
- Department of Clinical Laboratory, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Kazushi Maruo
- Department of Medical Engineering, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Shayne Morris
- Department of Neurosurgery, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Sayoko Yonemoto
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Daisuke Hayashi
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Naohiko Fujii
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Hiroyuki Narahara
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Yoshiaki Inui
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Sumio Kawata
- Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
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47
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Andreadis P, Kafantari K, Agapidou A, Vakalopoulou S, Vlachaki E. Successful Outcome of Severe Intra-cerebral Bleeding Associated with Acquired Factor V Inhibition: Utilization of Multiple Therapeutic Agents. Balkan Med J 2018; 35:112-115. [PMID: 28903884 PMCID: PMC5820439 DOI: 10.4274/balkanmedj.2017.0158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Acquired coagulation factor inhibitors are antibodies that either inhibit activity or increase the clearance of a clotting factor and lead to an increased risk of bleeding. Most of the time, the disorder is attributed to factor VIII inhibition (acquired haemophilia A); however, other coagulation factors could also be implicated. Case Report: Herein, we report an interesting case of a patient who underwent coronary artery bypass grafting and received antibiotic treatment after surgery with third generation cephalosporin. A month later, he presented with extreme bleeding diathesis and cerebral haemorrhage. Following a thorough clinical and laboratory investigation, an acquired factor V inhibitor was diagnosed. The patient received treatment with corticosteroids, intravenous immunoglobulins, anti-CD20 monoclonal antibodies (rituximab), cyclophosphamide and recombinant factor VIIa. Finally, despite the poor initial prognosis, the patient managed to achieve a full recovery. Conclusion: As there are no clear guidelines on acquired coagulation inhibitor treatment, reports of such cases could offer insight for future therapy choices. The case was unique because the treatment regimen included a combination of multiple therapeutic agents including rituximab.
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Affiliation(s)
- Panagiotis Andreadis
- Clinic of Internal Medicine, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Katerina Kafantari
- Clinic of Internal Medicine, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Aleka Agapidou
- Clinic of Hematology, Homerton University Hospital, Homerton Row, London
| | - Sofia Vakalopoulou
- Clinic of Internal Medicine, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Efthymia Vlachaki
- Clinic of Internal Medicine, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece
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Abstract
Historically, inhibitors to coagulation factor V (FV) most often have developed in patients treated with bovine thrombin, a topical hemostatic agent used during surgical procedures. With the advent of newer hemostatic agents, and the concurrent diminished use of bovine thrombin, the incidence of FV inhibitors has fallen. Nevertheless, FV inhibitors are occasionally seen on an idiopathic basis as well as in association with medications, malignancies, autoimmune disorders, pregnancy, and infections. Factor V inhibitors may present with life-threatening bleeding or thrombosis, or they may be discovered incidentally as a coagulation screening test abnormality. Management of patients with FV inhibitors is challenging and consists of control of bleeding and eradication of the inhibitor. In this short overview we review the role of platelet and plasma FV in hemostasis and discuss the unique characteristics, clinical features, diagnosis, treatment, and prognosis associated with FV inhibitors.
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49
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Olson NJ, Ornstein DL. Hematuria in a Former Smoker. Clin Chem 2017; 63:1774. [PMID: 29089324 DOI: 10.1373/clinchem.2017.274597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/10/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Nicholas J Olson
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, and Geisel School of Medicine at Dartmouth, Hanover, NH.
| | - Deborah L Ornstein
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, and Geisel School of Medicine at Dartmouth, Hanover, NH
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50
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Theron A, Burcheri S, Vacheret F, Hillaire-Buys D, Sauguet P, Schved JF, Faillie JL, Biron-Andreani C. Iatrogenic acquired factor V inhibitors: A case report and review of the French pharmacovigilance database. Thromb Res 2017; 157:154-156. [PMID: 28755628 DOI: 10.1016/j.thromres.2017.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 06/02/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Alexandre Theron
- Department of Laboratory Haematology, University Hospital of Montpellier, France
| | - Sara Burcheri
- Department of Clinical Haematology, Hospital of Perpignan, France
| | | | | | - Pauline Sauguet
- Department of Laboratory Haematology, University Hospital of Montpellier, France
| | - Jean-François Schved
- Department of Laboratory Haematology, University Hospital of Montpellier, France
| | - Jean-Luc Faillie
- Department of Pharmacology, University Hospital of Montpellier, France
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