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Clauser S, Calmette L. [How to interpret and pursue a prolonged quick time or APTT]. Rev Med Interne 2024:S0248-8663(24)00564-2. [PMID: 38811304 DOI: 10.1016/j.revmed.2024.05.002] [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: 11/15/2023] [Revised: 03/20/2024] [Accepted: 05/02/2024] [Indexed: 05/31/2024]
Abstract
The standard hemostasis workup [quick time (QT), and activated partial thrombin time (APTT)] is very commonly prescribed but its interpretation is often difficult for practitioners who are not specialized in hemostasis. Here, we review the principles of the diagnostic approach to these tests. Only a very basic knowledge of the coagulation cascade is necessary to identify which clotting factor tests to prescribe and to interpret the results. Deficiency in several clotting factors suggests liver dysfunction, disseminated intravascular coagulation (DIC) or vitamin K deficiency. If a single factor is deficient, we review the different causes of acquired deficiencies and briefly discuss the characteristics of the different congenital defects, which generally require specialized management. Lupus anticoagulant is a common and generally benign cause of prolonged APTT to be aware of, which is not related to a hemorrhagic risk. A good knowledge of the diagnostic approach to abnormal QT or APTT generally allows the resolution of the most common situations.
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Affiliation(s)
- S Clauser
- Service d'hématologie-immunologie-transfusion, hôpital Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt cedex, France; UFR des sciences de la santé Simone-Veil, université de Versailles Saint-Quentin-en-Yvelines, 2, avenue de la Source-de-la-Bièvre, 78180 Montigny-le-Bretonneux, France.
| | - L Calmette
- Service d'hématologie-immunologie-transfusion, hôpital Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt cedex, France
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Qiu C, Huang C, Chen X, Gu D. The identification of a novel compound heterozygous mutation in hereditary human coagulation factor VII deficiency following a bamboo leaf green snake bite. Lab Med 2024:lmae012. [PMID: 38447534 DOI: 10.1093/labmed/lmae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
Hereditary factor VII (FVII) deficiency is an uncommon autosomal recessive disorder associated with mutations in the F7 gene, and laboratory investigations usually reveal isolated prolongation in prothrombin time (PT)/international normalized ratio (INR). Venom-induced consumptive coagulopathy (VICC) is distinguished by the activation of the coagulation pathway, which is triggered by procoagulant toxins in snake venom. Diagnosing snakebites in patients with hereditary FVII deficiency presents a challenge because prolonged time PT/INR is considered the most valuable diagnostic method for VICC. Therefore, it is possible that certain patients may not promptly receive an accurate diagnosis of hereditary FVII deficiency. We present a pedigree featuring hereditary FVII deficiency, which was diagnosed through Sanger sequencing, following a bamboo leaf green snake bite.
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Affiliation(s)
- Chuanghua Qiu
- Department of Laboratory Medicine, Shenzhen Second People's Hospital Shenzhen China
| | - Chunxiu Huang
- Department of Laboratory Medicine, Shenzhen Second People's Hospital Shenzhen China
| | - Xueyan Chen
- Department of Clinical Laboratory, The People's Hospital of Longhua Shenzhen, Shenzhen, China
| | - Dayong Gu
- Department of Laboratory Medicine, Shenzhen Second People's Hospital Shenzhen China
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3
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Preisler B, Pezeshkpoor B, Merzenich A, Ohlenforst S, Rühl H, Ivaškevičius V, Scholz U, Bönigk H, Eberl W, Zieger B, Pavlova A, Oldenburg J. Genetic Landscape of Factor VII Deficiency: Insights from a Comprehensive Analysis of Pathogenic Variants and Their Impact on Coagulation Activity. Int J Mol Sci 2024; 25:2384. [PMID: 38397060 PMCID: PMC10889322 DOI: 10.3390/ijms25042384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
Congenital factor VII (FVII) deficiency is a rare genetic bleeding disorder characterized by deficient or reduced activity of coagulation FVII. It is caused by genetic variants in the F7 gene. We aimed to evaluate the rate of detection of pathogenic variants in the F7 gene in a large group of patients with FVII deficiency and investigate the correlations between the F7 genotype and FVII activity (FVII:C). Moreover, the influence of the common genetic variant rs6046: c.1238G>A; p.(Arg413Gln), designated as the M2 allele, on FVII:C was investigated. Genetic analysis of the F7 gene was performed on 704 index patients (IPs) using either direct Sanger- or next-generation sequencing. Genetic variants were detected in 390 IPs, yielding a variant detection rate (VDR) of 55%. Notably, the VDR exhibited a linear decline with increasing FVII:C levels. We identified 124 genetic variants, of which 48 were not previously reported. Overall, the frequency of the M2 allele was considerably higher in patients with mild deficiency (FVII:C > 20 IU/dl). Furthermore, IPs lacking an identified pathogenic variant exhibited a significantly higher prevalence of the M2 allele (69%) compared to IPs with a disease-causing variant (47%). These results strongly support the association of the M2 allele with decreased FVII:C levels. This study shows the utility of FVII:C as a predictive marker for identifying pathogenic variants in patients with FVII deficiency. The M2 allele contributes to the reduction of FVII:C levels, particularly in cases of mild deficiency.
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Affiliation(s)
- Barbara Preisler
- Institute of Experimental Hematology and Transfusion Medicine, University of Bonn, Faculty of Medicine, University Clinic Bonn, 53127 Bonn, Germany; (B.P.); (B.P.); (S.O.); (H.R.); (V.I.); (A.P.)
| | - Behnaz Pezeshkpoor
- Institute of Experimental Hematology and Transfusion Medicine, University of Bonn, Faculty of Medicine, University Clinic Bonn, 53127 Bonn, Germany; (B.P.); (B.P.); (S.O.); (H.R.); (V.I.); (A.P.)
| | - Anja Merzenich
- Institute of Experimental Hematology and Transfusion Medicine, University of Bonn, Faculty of Medicine, University Clinic Bonn, 53127 Bonn, Germany; (B.P.); (B.P.); (S.O.); (H.R.); (V.I.); (A.P.)
| | - Sandra Ohlenforst
- Institute of Experimental Hematology and Transfusion Medicine, University of Bonn, Faculty of Medicine, University Clinic Bonn, 53127 Bonn, Germany; (B.P.); (B.P.); (S.O.); (H.R.); (V.I.); (A.P.)
| | - Heiko Rühl
- Institute of Experimental Hematology and Transfusion Medicine, University of Bonn, Faculty of Medicine, University Clinic Bonn, 53127 Bonn, Germany; (B.P.); (B.P.); (S.O.); (H.R.); (V.I.); (A.P.)
| | - Vytautas Ivaškevičius
- Institute of Experimental Hematology and Transfusion Medicine, University of Bonn, Faculty of Medicine, University Clinic Bonn, 53127 Bonn, Germany; (B.P.); (B.P.); (S.O.); (H.R.); (V.I.); (A.P.)
| | - Ute Scholz
- Center of Hemostasis, MVZ Labor Leipzig, 04289 Leipzig, Germany;
| | - Hagen Bönigk
- MVZ Limbach Magdeburg, Lab Dr. Franke, Bönigk and Colleagues, Center of Coagulation Disorders and Vascular Diseases, 39104 Magdeburg, Germany;
| | - Wolfgang Eberl
- Pediatric Hematology and Oncology, Klinikum Braunschweig, 38118 Braunschweig, Germany;
| | - Barbara Zieger
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center–University of Freiburg, Faculty of Medicine, 79110 Freiburg, Germany;
| | - Anna Pavlova
- Institute of Experimental Hematology and Transfusion Medicine, University of Bonn, Faculty of Medicine, University Clinic Bonn, 53127 Bonn, Germany; (B.P.); (B.P.); (S.O.); (H.R.); (V.I.); (A.P.)
| | - Johannes Oldenburg
- Institute of Experimental Hematology and Transfusion Medicine, University of Bonn, Faculty of Medicine, University Clinic Bonn, 53127 Bonn, Germany; (B.P.); (B.P.); (S.O.); (H.R.); (V.I.); (A.P.)
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Seanoon K, Kitiyanant V, Payongsri P, Sirachainan N, Angchaisuksiri P, Chuansumrit A, Hongeng S, Tanratana P. Site-directed mutagenesis of tissue factor pathway inhibitor-binding exosite D60A on factor VII results in a new factor VII variant with lower coagulant activity. Res Pract Thromb Haemost 2024; 8:102309. [PMID: 38318153 PMCID: PMC10840347 DOI: 10.1016/j.rpth.2023.102309] [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: 04/26/2023] [Revised: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 02/07/2024] Open
Abstract
Background Recombinant factor (F)VIIa (rFVIIa) has been approved by the US Food and Drug Administration for the treatment of hemophilia A and B with inhibitors and congenital FVII deficiency. Moreover, the investigational uses of rFVIIa are becoming of interest since it can be used to treat various clinical bleeding conditions. However, there is evidence showing that rFVIIa is a potent procoagulant agent that potentially leads to an increased risk of thrombotic complications. Objectives To design a new rFVII with lower coagulant activity that could potentially be used as an alternative hemostatic agent aiming to minimize the risk of thrombogenicity. Methods D60A was introduced into the F7 sequence by polymerase chain reaction-based mutagenesis. Wild type (WT) and D60A were generated in human embryonic kidney 293T cells by stable transfection. FVII coagulant activities were determined by amidolytic cleavage of the FVIIa-specific substrate, 2-step FXa generation, thrombin generation (TG), and clot-based assays. Results WT and D60A demonstrated similar FVIIa amidolytic activity. However, D60A showed approximately 50% activity on FX activation and significantly longer lag time in the TG assay than that shown by WT. The clotting time produced by D60A spiked in FVII-deficient plasma was significantly prolonged than that of WT. Additionally, the ex vivo plasma half-lives of WT and D60A were comparable. Conclusion D60A demonstrated lower coagulant activities, most likely due to the weakening of FX binding, leading to impaired FX activation and delayed TG and fibrin formation. Considering that a plasma FVII level of 15% to 25% is adequate for normal hemostasis, D60A is a molecule of interest for future development of an rFVII with a lesser extent of thrombogenicity.
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Affiliation(s)
- Karnsasin Seanoon
- Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Vorawat Kitiyanant
- Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok, Thailand
- Ramathibodi Hemostasis and Thrombosis Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Panwajee Payongsri
- Department of Biotechnology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Nongnuch Sirachainan
- Ramathibodi Hemostasis and Thrombosis Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pantep Angchaisuksiri
- Ramathibodi Hemostasis and Thrombosis Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ampaiwan Chuansumrit
- Ramathibodi Hemostasis and Thrombosis Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suradej Hongeng
- Ramathibodi Hemostasis and Thrombosis Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pansakorn Tanratana
- Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok, Thailand
- Ramathibodi Hemostasis and Thrombosis Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Hassan WU, Ahmad M, Abdelazeem B, Koduru U, Kunadi A. Acquired Factor VIII Deficiency in Chronic Myeloid Leukemia: A Case Report. Cureus 2023; 15:e48802. [PMID: 38098897 PMCID: PMC10721210 DOI: 10.7759/cureus.48802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/17/2023] Open
Abstract
Factor VIII deficiency is mostly seen in hemophilia A, an X-linked recessive disorder. Patients would have a past medical history of bleeding diathesis or a family history of bleeding disorder. Acquired deficiencies of factor VIII are rare; some cases have been reported in solid malignancies. We present this case of acquired factor VIII deficiency in chronic myeloid leukemia (CML). A 72-year-old man was incidentally found to have leukocytosis at 31,000 and a platelet count of 3.2 million on a routine complete blood count (CBC). Prothrombin time (PT), international normalized ratio (INR), and partial thromboplastin time (PTT) showed an isolated elevation of PTT at 38.1 and a low factor VIII activity level at 39. The patient did not have any history or physical examination suggestive of bleeding diathesis. A bone marrow biopsy confirmed the BCR/ABL mutation, a diagnosis of CML was made, and the patient was started on dasatinib for one month. His PTT normalized after treatment for CML, suggesting a deficiency of factor VIII likely related to CML. The aim of this study is to highlight a case with acquired factor VIII deficiency due to CML and to emphasize the importance of coagulation workup in all newly diagnosed CML patients.
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Affiliation(s)
| | | | | | - Ujwala Koduru
- Internal Medicine, Mclaren Flint Hospital, Flint, USA
| | - Arvind Kunadi
- Internal Medicine, Mclaren Flint Hospital, Flint, USA
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Furlan A, Sartori F, Gherlinzoni F. Acquired Isolated Factor VII Deficiency in Plasma Cell Dyscrasias: A Brief Presentation of Two Plasma-Cell-Leukemia-Related Cases and Review of Literature. J Clin Med 2023; 12:5837. [PMID: 37762778 PMCID: PMC10531634 DOI: 10.3390/jcm12185837] [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: 08/05/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Acquired isolated factor VII (FVII) deficiency is a rare but important discovery in patients with plasma cell disorders with significant therapeutic and prognostic implications. The present analysis and review of cases reported in the literature is intended to highlight disease-related characteristics associated with this rare clotting defect, clinical manifestations and outcome, and potential underlying mechanisms, and to provide guidance on how to manage these patients in terms of prophylactic and therapeutic measures. The discovery of acquired FVII deficiency in a patient with multiple myeloma (MM) or monoclonal gammopathy of uncertain significance (MGUS) should prompt an evaluation for AL amyloidosis, particularly for amyloid hepatosplenic involvement, whenever not previously documented. Acquired FVII deficiency in patients with MM and AL amyloidosis is frequently associated with severe bleeding diathesis, also related to a number of concomitant predisposing factors, adversely affecting the outcome. The prompt institution of a rapidly acting therapy is crucial to prevent severe bleeding complications and positively impact outcome. Recombinant activated factor VII (rVIIa) may represent a useful supportive care measure, both in treating active bleeding and in the peri-procedural setting. However, further clinical experience is needed to optimize the therapeutic management of this rare disorder.
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Affiliation(s)
- Anna Furlan
- Hematology Unit, Azienda ULSS2 Marca Trevigiana, 31100 Treviso, Italy; (F.S.); (F.G.)
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Salum HM, Lukumay J, Muze K, Swai P, Kindole C, Kipasika H, Apollo M, Chirande L, Furia F. Factor VII deficiency: a rare genetic bleeding disorder in a 7-year-old child: a case report. J Med Case Rep 2023; 17:138. [PMID: 37055867 PMCID: PMC10103398 DOI: 10.1186/s13256-023-03884-3] [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: 08/06/2022] [Accepted: 03/10/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Factor VII deficiency is a rare inherited bleeding disorder that has similar clinical presentation to hemophilia. CASE REPORT A 7-year-old male child of African origin experienced recurrent nasal bleeding since 3 years of age and recurrent swelling of the joints that was remarkable at the age of 5-6 years. He received multiple blood transfusions and has been managed as a patient with hemophilia until he presented to our facility. Reviewed evaluation of the patient revealed abnormal prothrombin and normal activated partial thromboplastin time, FVII analysis showed activity level of less than 1%, and the diagnosis of FVII deficiency was made. The patient was treated with fresh frozen plasma, vitamin K injection, and tranexamic tablets. CONCLUSION Even though factor VII deficiency is an extremely rare bleeding disorder, it does occur in our setting. This case highlights the need for clinicians to consider this condition when faced with challenging patients presenting with bleeding disorders.
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Affiliation(s)
- Hajaj Mohamed Salum
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Joyce Lukumay
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kandi Muze
- Department of Paediatrics, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Peter Swai
- Department of Paediatrics, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Christina Kindole
- Department of Paediatrics, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Honesta Kipasika
- Department of Paediatrics, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Monica Apollo
- Department of Paediatrics, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Lulu Chirande
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Francis Furia
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Sharma R, Jamwal M, Senee HK, Singh N, Kumar N, Hans C, Kler A, Bansal D, Trehan A, Malhotra P, Ahluwalia J, Das R. Molecular spectrum of inherited FVII deficiency in North India revealed a recurrent variant with a founder effect. Haemophilia 2023; 29:591-599. [PMID: 36571800 DOI: 10.1111/hae.14730] [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: 05/28/2022] [Revised: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Inherited Factor VII (FVII) deficiency is commonest among the rare bleeding disorders. A small number of patients present in infancy with severe bleeding, and many may remain asymptomatic but detected before surgery/invasive procedures. Genetic testing may be helpful in predictive testing/prenatal diagnosis in severe cases. AIM Characterisation of clinical and genotypic spectrum of patients with inherited FVII deficiency. METHODS Retro-prospectively, 35 cases with prolonged prothrombin time and FVII activity (FVII:C) <50 IU/dl were subjected to targeted resequencing. After in-silico analysis, variant/s were validated by Sanger sequencing in index cases and family members. Haplotype analysis was done for F7 polymorphisms. RESULTS Severe FVII deficiency was found in 50% of patients (FVII:C ≤1 IU/dl), and 42.9% were asymptomatic. Clinical severity assessment revealed 17% severe, 17% moderate and 22.9% patients with mild bleeds. FVII levels ranged from .3 to 38 IU/dl. Molecular analysis revealed variants in 30/35 cases, of which 17 were homozygous, 10 were compound heterozygous and 3 were heterozygous. Twelve genetic variants were identified, one promoter variant c.-30A>C; seven missense (c.215C>G, c.244T>C, c.253G>C, c.904G>A, c.961C>T, c.1109G>T, c.1211G>A), two deletions (c.21delG, c.868_870delATC), and one each of nonsense c.634C>T and splice-site variant c.316+1G>A. Recurrent variants c.1109G>T and c.215C>G were found in 17 and 8 cases, 12 of the former cases were homozygous. They had the same haplotype, indicating the founder effect in North Indians. CONCLUSION This is the largest cohort of FVII genotyping from India, confirming heterogeneity in terms of clinical manifestations, FVII activity and zygosity of the variants with a limited genotypic phenotypic correlation.
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Affiliation(s)
- Ritika Sharma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manu Jamwal
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hari Kishan Senee
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Namrata Singh
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narender Kumar
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chander Hans
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anita Kler
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Department of Pediatrics (Hematology-Oncology Unit), Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Trehan
- Department of Pediatrics (Hematology-Oncology Unit), Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jasmina Ahluwalia
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reena Das
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Garg AK, Chaitanya S, Patnaik S, Kumar V. Spontaneous subgaleal haemorrhage in a newborn: A rare presentation of congenital factor VII deficiency due to homogenous missense mutation of factor VII gene. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2022. [DOI: 10.1016/j.phoj.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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10
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Clark JA, Hooser SB, Dreger DL, Burcham GN, Ekenstedt KJ. Investigation of a common canine factor VII deficiency variant in dogs with unexplained bleeding on autopsy. J Vet Diagn Invest 2022; 34:806-812. [PMID: 35949113 PMCID: PMC9446296 DOI: 10.1177/10406387221118581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The factor VII (FVII) protein is an integral component of the extrinsic coagulation pathway. Deleterious variants in the gene encoding this protein can result in factor VII deficiency (FVIID), a bleeding disorder characterized by abnormal (slowed) clotting with a wide range of severity, from asymptomatic to life-threatening. In canids, a single FVIID-associated variant, first described in Beagles, has been observed in 24 breeds and mixed-breed dogs. Because this variant is present in breeds of diverse backgrounds, we hypothesized that it could be a contributing factor to unexplained bleeding observed in some canine autopsy cases. DNA was extracted from paraffin-embedded tissue samples from 67 anticoagulant-negative autopsy cases with unexplained etiology for gross lesions of hemorrhage. Each dog was genotyped for the c.407G>A (F71) variant. Experimental controls included 3 known heterozygotes and 2 known homozygotes for the F71 variant, 2 normal dogs with known homozygous wild-type genotypes (F7WF7W), and 5 dogs with bleeding at autopsy that tested positive for anticoagulant rodenticide and were genotyped as F7WF7W. All 67 cases tested homozygous for the wild-type allele, indicating that the common FVIID variant was not responsible for the observed unexplained bleeding. Our work demonstrates the usefulness of retrospective studies utilizing veterinary diagnostic laboratory databases and tissue archives for genetic studies. In the case of FVIID, our results suggest that a singular molecular test for the F71 variant is not a high-yield addition to postmortem screening in these scenarios.
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Affiliation(s)
- Jessica A. Clark
- Department of Basic Medical Sciences, College
of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
| | - Stephen B. Hooser
- Animal Disease Diagnostic Laboratory,
Department of Comparative Pathobiology, College of Veterinary Medicine,
Purdue University, West Lafayette, IN, USA
| | - Dayna L. Dreger
- Department of Basic Medical Sciences, College
of Veterinary Medicine, Purdue University, West Lafayette, IN, USA. Current
address: National Human Genome Research Institute, NIH, Bethesda, MD,
USA
| | - Grant N. Burcham
- Animal Disease Diagnostic Laboratory,
Department of Comparative Pathobiology, College of Veterinary Medicine,
Purdue University, West Lafayette, IN, USA
| | - Kari J. Ekenstedt
- Department of Basic Medical Sciences, College
of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
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Krzyżanowski A, Gęca T, Sokołowska B, Kwiatek M, Miturski A, Stupak A, Terlecki P, Paluszkiewicz P, Kwaśniewska A. Thromboelastometry as an Ancillary Tool for Evaluation of Coagulation Status after rFVIIa Therapy in a Pregnant Woman with Severe Hypoproconvertinemia-A Case Series and Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10918. [PMID: 36078653 PMCID: PMC9518547 DOI: 10.3390/ijerph191710918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/20/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
Introduction: Factor VII (FVII) deficiency is a rare hemorrhagic diathesis. In females, heavy menstrual and postpartum bleeding can appear as a consequence of its deficiency. Supplementation of the recombinant FVIIa is widely accepted. The supplementation effect in FVII-deficient subjects is difficult to predict, and severe hemorrhage has been described even when FVII levels after supplementation were within normal ranges. The aim of this report is to present the application of thromboelastometry to control the coagulation status in a patient with severe FVII deficiency during pregnancy and delivery, supplemented by rFVIIa per protocol complicated with life-threatening venous thromboembolism. Methods: Rotational thromboelastometry (ROTEM) was performed in 16 pregnant women: in one 28 year old primigravida at 35 weeks of pregnancy with congenital FVII deficiency after rFVIIa administration and 15 healthy women at 38 gestational weeks. The results were compared. Results: The thromboelastometry results showed significant shortening of the clotting time in the extrinsic and the intrinsic pathway in the hypoproconvertinemia patient after rFVIIa administration in relation to healthy pregnant women. A significant reduction in maximum lysis of the clot after FVII supplementation was observed. Conclusions: The thromboelastometry results showed a significant hypercoagulable state with hypoproconvertinemia. Thrombotic complications after delivery might be prevented by the reduction in rFVIIa guided by thromboelastometry. Thromboelastometry performed on a pregnant woman with factor VII deficiency during the supplementation of rFVIIa in peripartum time might be helpful in order to determine an individual, effective dosage regimen of rFVIIa to ensure full correction of clotting disorders without the tendency to develop thrombosis, but further studies are needed.
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Affiliation(s)
- Arkadiusz Krzyżanowski
- Chair and Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, 20-081 Lublin, Poland
| | - Tomasz Gęca
- Chair and Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, 20-081 Lublin, Poland
| | - Bożena Sokołowska
- Chair and Department of Haematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-059 Lublin, Poland
| | - Maciej Kwiatek
- Chair and Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, 20-081 Lublin, Poland
| | - Andrzej Miturski
- Chair and Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, 20-081 Lublin, Poland
| | - Aleksandra Stupak
- Chair and Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, 20-081 Lublin, Poland
| | - Piotr Terlecki
- Chair and Department of Vascular Surgery and Angiology, Medical University of Lublin, 20-081 Lublin, Poland
| | - Piotr Paluszkiewicz
- Department of General, Oncological and Metabolic Surgery, Institute of Haematology and Transfusion Medicine, 14 I. Gandhi Str., 02-776 Warsaw, Poland
| | - Anna Kwaśniewska
- Chair and Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, 20-081 Lublin, Poland
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12
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Clinical phenotype and F7 gene genotype in 40 Tunisian patients with congenital factor VII deficiency. Blood Coagul Fibrinolysis 2022; 33:280-284. [PMID: 35802509 DOI: 10.1097/mbc.0000000000001139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Congenital factor VII (FVII) deficiency is an autosomal recessive bleeding disorder characterized by a weak phenotypic and genotypic correlation. This study aimed to determine the genetic alterations of 40 Tunisian patients and to evaluate their relationships with the collected clinical and biological data. Forty FVII-deficient Tunisian patients have been included in this study. First, diagnosis of the FVII deficiency was made on the basis of FVII coagulant activity (FVII:c) levels performed using the prothrombin time assay. Then, clinical and anamnesis data were set up and filed out from the regional registry of bleeding disorders and the medical file of each patient. Finally, genetic alterations were determined by direct sequencing of the coding regions, intron/exons boundaries of the F7 gene. Clinical heterogeneity was noticed, and the direct sequencing allowed the identification of 13 F7 gene mutations of which one was a novel mutation. The clinical manifestations are variably associated with FVII activity FVII:c levels. Lack of relations between severity of clinical manifestations and genotypes was observed; however, a relationship between the nonpathogeneous mutations and clinical phenotypes was noticed. A wide phenotypic inter-individual variability was detected, which suggests the presence of other extra-genetic components influencing the expressivity of the deficiency.
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13
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Bollici Martínez J, Valiente Álvarez JL, Pérez Castillejo S, López Pérez R, Aguilar Franco C, Del Villar Sordo V. Epidural analgesia in pregnant with deficit of factor VII. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:242-244. [PMID: 35534386 DOI: 10.1016/j.redare.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 12/27/2020] [Indexed: 06/14/2023]
Abstract
The congenital deficit of FVII of coagulation it's an anomaly of genetic transmission autosomal recessive type, it can occur with clinical manifestations like hematomas and spontaneous bleeding or not. The normal levels of FVII it's found between 70%-130% of the laboratory reference value. For unknown reasons there is a poor correlation between levels of FVII and bleeding risk. During pregnancy coagulation can be significantly altered, there is a no clear consensus and a very few information about how to act during labor in a patient with a FVII deficit. The case of a 35-year-old patient with 35 weeks of gestation and congenital deficit of the coagulation FVII (36%) is presented, epidural analgesia is performed during labor previously administering activated recombinant FVII (rFVIIa) without complications (Spinal hematoma, postpartum bleeding, thrombosis).
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Affiliation(s)
- J Bollici Martínez
- Servicio de Anestesiología y Reanimación, Complejo Asistencial de Soria, Soria, Spain.
| | - J L Valiente Álvarez
- Servicio de Anestesiología y Reanimación, Complejo Asistencial de Soria, Soria, Spain
| | - S Pérez Castillejo
- Servicio de Anestesiología y Reanimación, Complejo Asistencial de Soria, Soria, Spain
| | - R López Pérez
- Servicio de Anestesiología y Reanimación, Complejo Asistencial de Soria, Soria, Spain
| | - C Aguilar Franco
- Servicio de Hematología, Complejo Asistencial de Soria, Soria, Spain
| | - V Del Villar Sordo
- Servicio de Medicina Interna y Unidad de Investigación, Complejo Asistencial de Soria, Soria, Spain
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14
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Zhang X, Wang S, Leng S, Feng Q, Zhang Y, Xu S, Zhang L, Zhang X, Fang Y, Peng J, Sheng Z. Novel factor VII gene mutations in six families with hereditary coagulation factor VII deficiency. J Clin Lab Anal 2021; 35:e23905. [PMID: 34342048 PMCID: PMC8418470 DOI: 10.1002/jcla.23905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/02/2021] [Accepted: 06/25/2021] [Indexed: 12/19/2022] Open
Abstract
Introduction Hereditary human coagulation factor VII (FVII) deficiency is an inherited autosomal recessive hemorrhagic disease involving mutations in the F7 gene. The sites and types of F7 mutations may influence the coagulation activities of plasma FVII (FVII: C) and severity of hemorrhage symptoms. However, the specific mutations that impact FVII activity are not completely known. Methods We tested the coagulation functions and plasma activities of FVII in seven patients recruited from six families with hereditary FVII deficiency and sequenced the F7 gene of the patients and their families. Then, we analyzed the genetic information from the six families and predicted the structures of the mutated proteins. Results In this study, we detected 11 F7 mutations, including four novel mutations, in which the mutations p.Phe84Ser and p.Gly156Cys encoded the Gla and EGF domains of FVII, respectively, while the mutation p.Ser339Leu encoded the recognition site of the enzymatic protein and maintained the conformation of the catalytic domain structure. Meanwhile, the mutation in the 5′ untranslated region (UTR) was closely associated with the mRNA regulatory sequence. Conclusion We have identified novel genetic mutations and performed pedigree analysis that shed light on the pathogenesis of hereditary human coagulation FVII deficiency and may contribute to the development of treatments for this disease. In this study, we performed coagulation index tests and gene sequencing on 7 hereditary FVII deficiency patients and their family members to explain the pathogenesis of the disease based on the analysis of their genetic information. Also, we compared the structures of newly discovered mutant proteins with the wild type and predicted their pathogenicity. To sum up, this study expands our insight on the pathogenesis of hereditary human coagulation FVII deficiency.
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Affiliation(s)
- Xiaoyu Zhang
- Department of Hematology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shuwen Wang
- Department of Hematology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shaoqiu Leng
- Department of Hematology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qi Feng
- Department of Hematology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yanqi Zhang
- Shandong Provincial Key Laboratory of Immunohematology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shuqian Xu
- Department of Hematology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lei Zhang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Xinsheng Zhang
- Shandong Blood Center, Shandong Hemophilia Treatment Center, Jinan, China
| | - Yunhai Fang
- Shandong Blood Center, Shandong Hemophilia Treatment Center, Jinan, China
| | - Jun Peng
- Department of Hematology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Zi Sheng
- Department of Hematology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
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15
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Liang K, Nikuze L, Zhang F, Lu Z, Wei M, Wei H. Identification of two novel mutations in three children with congenital factor VII deficiency. Blood Coagul Fibrinolysis 2021; 32:340-343. [PMID: 33587484 PMCID: PMC8279893 DOI: 10.1097/mbc.0000000000001022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/11/2021] [Accepted: 01/25/2021] [Indexed: 11/26/2022]
Abstract
Congenital factor VII deficiency (FVIID) is a rare F7 gene mutation causing bleeding disorder inherited in an autosomal recessive manner. In this study, we aimed to identify genetic defects and analyze their relationships with phenotype in three Chinese FVIID patients. The diagnosis of FVIID was made based on FVII coagulant activity (FVII:C) levels assessed through prothrombin time assay. Direct sequencing and protein modeling were performed to detect genetic mutations and the resulting protein expression. Patient 1, a 2-year-old girl, presented with mild bleeding and was found to have a FVII:C of 0.2% and a compound heterozygous F7 Cys389Gly/Cys115Arg mutation. Patient 2, a 7-year-old boy, consulted for moderate bleeding and was found to have a FVII:C of 0.8% and a compound heterozygous F7 Thr241Asn/Pro324Leu mutation. Patient 3, a 5-year-old boy who developed a mild bleeding after trauma was found to have a FVII:C of 1.8% and a compound heterozygous F7 Thr241Asn/ IVS5-2A>G mutation. We hereby report three congenital FVIID patients with FVII:C less than 2% and their respective F7 mutations, two of which (F7 Cys115Arg, Pro324Leu) are novel. The molecular model analysis of the two novel mutations F7 Cys115Arg and Pro324Leu respectively indicated impairment of the proper folding of epidermal growth factor 1 domain situated on F7 gene and impairment of the procoagulant function of FVII both leading to the congenital deficiency of FVII.
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Affiliation(s)
| | | | - Fuyong Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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16
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Andersen E, Chollet ME, Sletten M, Stavik B, Skarpen E, Backe PH, Thiede B, Glosli H, Henriksson CE, Iversen N. Molecular Characterization of Two Homozygous Factor VII Variants Associated with Intracranial Bleeding. Thromb Haemost 2021; 121:1588-1598. [PMID: 33742435 DOI: 10.1055/a-1450-8568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Clinical parameters have been extensively studied in factor (F) VII deficiency, but the knowledge of molecular mechanisms of this disease is scarce. We report on three probands with intracranial bleeds at an early age, one of which had concomitant high titer of FVII inhibitor. The aim of the present study was to identify the causative mutations and to elucidate the underlying molecular mechanisms. All nine F7 exons were sequenced in the probands and the closest family members. A homozygous deletion in exon 1, leading to a frame shift and generation of a premature stop codon (p.C10Pfs*16), was found in proband 1. Probands 2 and 3 (siblings) were homozygous for a missense mutation in exon 8, resulting in a glycine (G) to arginine (R) substitution at amino acid 240 (p.G240R). All probands had severely reduced FVII activity (FVII:C < 1 IU/dL). Treatment consisted of recombinant FVIIa and/or plasma concentrate, and proband 1 developed a FVII inhibitor shortly after initiation of treatment. The FVII variants were overexpressed in mammalian cell lines. No FVII protein was produced in cells expressing the p.C10Pfs*16 variant, and the inhibitor development in proband 1 was likely linked to the complete absence of circulating FVII. Structural analysis suggested that the G to R substitution in FVII found in probands 2 and 3 would destabilize the protein structure, and cell studies demonstrated a defective intracellular transport and increased endoplasmic reticulum stress. The molecular mechanism underlying the p.G240R variant could be reduced secretion caused by protein destabilization and misfolding.
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Affiliation(s)
- Elisabeth Andersen
- Department of Hematology, Oslo University Hospital, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Maria Eugenia Chollet
- Department of Hematology, Oslo University Hospital, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Marit Sletten
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Benedicte Stavik
- Department of Hematology, Oslo University Hospital, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Ellen Skarpen
- Core Facility for Advanced Light Microscopy, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Paul Hoff Backe
- Department of Microbiology, Oslo University Hospital, Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Bernd Thiede
- Department of Biosciences, University of Oslo, Oslo, Norway
| | - Heidi Glosli
- Department of Pediatric Research, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Centre for Rare Disorders, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Carola Elisabeth Henriksson
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nina Iversen
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
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17
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Bollici Martínez J, Valiente Álvarez JL, Pérez Castillejo S, López Pérez R, Aguilar Franco C, Del Villar Sordo V. Epidural analgesia in pregnant with deficit of factor VII. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 69:S0034-9356(21)00054-2. [PMID: 33726919 DOI: 10.1016/j.redar.2020.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 12/05/2020] [Accepted: 12/27/2020] [Indexed: 06/12/2023]
Abstract
The congenital deficit of FVII of coagulation it's an anomaly of genetic transmission autosomal recessive type, it can occur with clinical manifestations like hematomas and spontaneous bleeding or not. The normal levels of FVII it's found between 70%-130% of the laboratory reference value. For unknown reasons there is a poor correlation between levels of FVII and bleeding risk. During pregnancy coagulation can be significantly altered, there is a no clear consensus and a very few information about how to act during labor in a patient with a FVII deficit. The case of a 35-year-old patient with 35 weeks of gestation and congenital deficit of the coagulation FVII (36%) is presented, epidural analgesia is performed during labor previously administering activated recombinant FVII (rFVIIa) without complications (Spinal hematoma, postpartum bleeding, thrombosis).
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Affiliation(s)
- J Bollici Martínez
- Servicio de Anestesiología y Reanimación, Complejo Asistencial de Soria, Soria, España.
| | - J L Valiente Álvarez
- Servicio de Anestesiología y Reanimación, Complejo Asistencial de Soria, Soria, España
| | - S Pérez Castillejo
- Servicio de Anestesiología y Reanimación, Complejo Asistencial de Soria, Soria, España
| | - R López Pérez
- Servicio de Anestesiología y Reanimación, Complejo Asistencial de Soria, Soria, España
| | - C Aguilar Franco
- Servicio de Hematología, Complejo Asistencial de Soria, Soria, España
| | - V Del Villar Sordo
- Servicio de Medicina Interna y Unidad de Investigación, Complejo Asistencial de Soria, Soria, España
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18
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Factor VII Deficiency in Patients Receiving Chronic Packed Cell Transfusions. J Pediatr Hematol Oncol 2021; 43:e268-e271. [PMID: 32520845 DOI: 10.1097/mph.0000000000001854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 05/09/2020] [Indexed: 11/26/2022]
Abstract
Acquired factor VII deficiency is a rare coagulopathy that has not been reported in transfusion-dependent patients so far. In this study, we reviewed files of 26 transfusion-dependent patients for coagulation profiles, factor V levels, factor VII levels, possible environmental factors influencing factor VII levels, and bleeding history. In 26 of 29 patients (89.6%), we found mild factor VII deficiency (<60%) with levels ranging between 35% and 56%. Bleeding history was unremarkable. We concluded that transfusion-dependent patients may have mild factor VII deficiency with no bleeding tendency under physiologic conditions.
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19
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Wasiluk T, Rogowska A, Boczkowska-Radziwon B, Zebrowska A, Bolkun L, Piszcz J, Radziwon P. Maintaining plasma quality and safety in the state of ongoing epidemic - The role of pathogen reduction. Transfus Apher Sci 2021; 60:102953. [PMID: 33023853 PMCID: PMC7832281 DOI: 10.1016/j.transci.2020.102953] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 01/22/2023]
Abstract
In the field of transfusion medicine, many pathogen reduction techniques (PRTs) are currently available, including those based on photochemical (PI) and photodynamic inactivation (PDI). This is particularly important in the face of emerging viral pathogens that may pose a threat to blood recipients, as in the case of the COVID-19 pandemic. However, PRTs have some limitations, primarily related to their adverse effects on coagulation factors, which should be considered before their intended use. A comprehensive search of PubMed, Wiley Online Library and Science Direct databases was conducted to identify original papers. As a result, ten studies evaluating fresh plasma and frozen-thawed plasma treated with different PI/ PDI methods and evaluating concentrations of coagulation factors and natural anticoagulants both before and after photochemical treatment were included in the review. The use of PI and PDI is associated with a significant decrease in the activity of all analysed coagulation factors, while the recovery of natural anticoagulants remains at a satisfactory level, variable for individual inactivation methods. In addition, the published evidence reviewed above does not unequivocally favour the implementation of PI/PDI either before freezing or after thawing as plasma products obtained with these two approaches seem to satisfy the existing quality criteria. Based on current evidence, if implemented responsibly and in accordance with the current guidelines, both PI and PDI can ensure satisfactory plasma quality and improve its safety.
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Affiliation(s)
- Tomasz Wasiluk
- Regional Centre for Transfusion Medicine, Bialystok, Poland.
| | - Anna Rogowska
- Regional Centre for Transfusion Medicine, Bialystok, Poland
| | | | | | - Lukasz Bolkun
- Department of Haematology, Medical University of Bialystok, Bialystok, Poland
| | - Jaroslaw Piszcz
- Department of Haematology, Medical University of Bialystok, Bialystok, Poland
| | - Piotr Radziwon
- Regional Centre for Transfusion Medicine, Bialystok, Poland; Department of Haematology, Medical University of Bialystok, Bialystok, Poland
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20
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Application of radioisotope synovectomy in the ankle joint in a child with congenital factor VII deficiency. Turk Arch Pediatr 2021; 55:455-456. [PMID: 33414669 PMCID: PMC7750345 DOI: 10.14744/turkpediatriars.2020.84669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/04/2020] [Indexed: 12/04/2022]
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21
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Kim DH, Park CY, Cho SR, Kim DW. Generation of a human induced pluripotent stem cell line, YCMi002-A, from a Factor VII deficiency patient carrying F7 mutations. Stem Cell Res 2020; 49:102026. [PMID: 33038747 DOI: 10.1016/j.scr.2020.102026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/11/2020] [Accepted: 09/28/2020] [Indexed: 11/25/2022] Open
Abstract
Factor VII (FVII) deficiency is the most common among the rare bleeding disorders, which is caused by mutations in coagulation factor VII. Clinical features caused by FVII deficiency vary from mild or asymptomatic to fatal cerebral hemorrhage. We generated an induced pluripotent stem cell (iPSC) line, YCMi002-A, from FVII deficiency patient-derived fibroblasts. YCMi002-A cells are characterized by novel compound heterozygous mutations. The c.345C > A; p.C115X is well known and the second one, c.1276C > T; p.Q426X, remains novel. YCMi002-A cells may help researchers to understand correlation between these mutations and the symptoms of FVII deficiency.
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Affiliation(s)
- Do-Hun Kim
- Department of Physiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea; Brain Korea 21 PLUS Program for Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Chul-Yong Park
- Center for Genome Engineering, Institute for Basic Science, Yuseong-gu, Daejeon 34126, South Korea
| | - Sung-Rae Cho
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Dong-Wook Kim
- Department of Physiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea; Brain Korea 21 PLUS Program for Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea; Severance Biomedical Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
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22
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Gorkom BLV, Holme PA, Joch C, Rogosch T, Feussner A, McKeand W, Roberts J, van Heerde W. Pharmacokinetics and pharmacodynamics of a recombinant fusion protein linking activated coagulation factor VII with human albumin (rVIIa-FP) in patients with congenital FVII deficiency. ACTA ACUST UNITED AC 2020; 25:17-25. [PMID: 31852380 DOI: 10.1080/16078454.2019.1700329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Recombinant fusion protein linking activated factor VIIa to human albumin (rVIIa-FP) is a therapeutic option designed to prevent and treat bleeding events in patients with congenital FVII deficiency with reduced infusion frequency compared to current FVII treatments. This study characterized the pharmacokinetics (PK) and pharmacodynamics (PD) of rVIIa-FP.Methods: A phase I multicenter, randomized, open-label, parallel-arm, single-dose study (NCT02470871) was conducted in nine patients with severe congenital FVII deficiency. Patients received their routine FVII product (30 IU/kg plasma-derived FVII [pdFVII] or 25 μg/kg recombinant activated FVII (rFVIIa) [eptacog alfa]), and were then randomly assigned to receive 100 or 300 μg/kg of rVIIa-FP. Blood samples for PK and PD assessments were drawn up to 48 hr after administration. FVIIa activity was determined using a one-stage clotting assay. PD parameters were derived from thrombin generation testing, using the Nijmegen hemostasis assay.Results: rVIIa-FP showed improved PK compared to rFVIIa, with 2- to 3-fold longer t1/2 and 4- to 8-fold lower clearance. Analysis of PD data showed a sustained suppression of lag time below 4.5 min (upper limit of healthy people) for rVIIa-FP compared to rFVIIa. AUEC and ECmax were similar across the two dose groups of rVIIa-FP and rFVIIa.Discussion: rVIIa-FP was well tolerated in patients with congenital FVII deficiency, showed a longer half-life and lower clearance compared to rFVIIa, and lag time remaining within healthy ranges for ≥8 hr.Conclusion: These results warrant further investigation into the efficacy of rVIIa-FP to control and prevent bleeding in patients with FVII deficiency.
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Affiliation(s)
- Britta Laros-van Gorkom
- Department of Hematology and Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pål André Holme
- Department of Hematology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | | | | | | | - Waander van Heerde
- Department of Hematology and Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Laboratory Medicine, Hematology Laboratory, Radboud University Medical Center, Nijmegen, Netherlands.,Enzyre, Novio Tech Campus, Nijmegen, The Netherlands
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23
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Lee EJ, Burey L, Abramovitz S, Desancho MT. Management of pregnancy in women with factor VII deficiency: A case series. Haemophilia 2020; 26:652-656. [PMID: 32590881 DOI: 10.1111/hae.14086] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/29/2020] [Accepted: 06/03/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Inherited factor VII deficiency is the most common autosomal recessive inherited bleeding disorder, with an estimated incidence of one per 500 000 cases in the general population. Bleeding manifestations correlate poorly with circulating FVII levels. During pregnancy, increases in FVII levels can occur in women with mild-moderate FVII deficiencies but not in those with severe deficiency. AIM We present five pregnant patients with FVII deficiency and describe the management during their pregnancies and peripartum periods. METHODS Retrospective analysis of six pregnancies in five women with FVII deficiency followed during pregnancy and delivery at an academic medical centre between January 2013 and December 2019. RESULTS Of the five patients, two had severe, one with moderate and two with mild FVII deficiency. Early postpartum haemorrhage (PPH) occurred in two patients. One of the two severe FVII-deficient patients had PPH with a laceration at delivery despite replacement therapy with recombinant factor VII. The other PPH occurred in a patient with mild FVII deficiency who delivered twins by caesarean section under general anaesthesia. Neuraxial anaesthesia was utilized in only one woman with mild deficiency whose FVII level normalized at the end of the pregnancy. CONCLUSIONS Management of delivery for women with FVII deficiency should be addressed on a case-by-case basis at centres with expertise in rare bleeding disorders, maternal foetal medicine and obstetric anaesthesiology. These management discussions should factor the patient's bleeding history, third trimester PT, FVII level, multiple gestation and mode of delivery.
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Affiliation(s)
- Eun-Ju Lee
- Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Laura Burey
- Department of Anesthesiology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Sharon Abramovitz
- Department of Anesthesiology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Maria T Desancho
- Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
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24
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Clinical problems and surgical interventions in inherited factor VII deficiency. Turk Arch Pediatr 2020; 55:184-190. [PMID: 32684764 PMCID: PMC7344127 DOI: 10.14744/turkpediatriars.2020.79069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/13/2020] [Indexed: 12/22/2022]
Abstract
Aim: Factor VII deficiency is one of the hereditary coagulation disorders that has autosomal reccessive inheritance and is observed relatively frequently (1/500 000). It is clinically heterogeneous, and may be asymptomatic or lead to life-threatening bleeding. Thus, there is no correlation between FVII activity and clinical findings. Plasma-derived and recombinant FVII concentrates are currently used for treatment. In countries where access to these products is lacking, fresh frozen plasma and prothrombin complex concentrates are also used, though they contain low amounts of factor FVII. In this study, we present the clinical properties, treatments, and surgical interventions used in patients followed up in our clinic with a diagnosis of factor FVII deficiency. Material and Methods: Patients who were diagnosed as FVII deficiency in Division of Pediatric Hematology and Oncology between July 1997 and July 2018, were included in the study. The patients’ demographic characteristics, symptoms at presentation, PT, aPTT, and FVII values, types of bleeding, and treatments and surgical interventions used, were recorded. The bleedings observed in the patients were classified by severity as asymptomatic, minor, and major. Results: A total of 18 patients (7 girls and 11 boys) with a mean age of 9.64±9.63 years were included in the study. The mean follow-up time was found as 78.06±54.4 months. When the bleedings were classified clinically, no bleeding was observed in eight patients (44.4%). The factor FVII level was found as <10% in three of these eight asymptomatic patients and above 20% in the others. Minor bleeding was observed in nine patients (50%) and major bleeding was observed in one patient. When the patients were classified as asymptomatic and symptomatic, there was no significant difference between the two groups in terms of FVII level (p=0.57). A total of 21 surgical interventions were performed in 14 (78%) of 18 patients who were being followed up. Conclusion: FVII deficiency has a very wide spectrum both clinically and in terms of approach to surgical interventions. Therefore, patients with factor FVII deficiency should be followed up and treated by comprehensive care centers with close collaboration of multiple disciplines.
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Girolami A, Paoletti M, Ferrari S, Garcia D. Peculiar Congenital Factor VII Defect with the Proposita and Her Mother Showing the Same Compound Heterozygosity for Thr384Met and Arg413Gln. Acta Haematol 2020; 144:100-104. [PMID: 32396910 DOI: 10.1159/000507071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/10/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate a family with factor VII (FVII) deficiency from Argentina. PATIENTS AND METHODS The proposita is a 14-year-old girl who presented with a mild to moderate bleeding tendency. Menorrhagia is controlled with periodical administration of small doses of recombinant FVII concentrate. The mother of the proposita has a similar bleeding tendency. RESULTS FVII activity in both patients was 20% of normal; FVII antigen was 35% of normal. Molecular biology investigation revealed that the proposita was compound heterozygote between Thr384Met and Arg413Gln. The mother had the same mutations. This was due to the fact that the father of the proposita and her maternal grandfather both carried, in spite of no relation, the same mutation, namely Arg413Gln. CONCLUSIONS The identical defect which presented in the propositaand her mother could be explained by the genetic analysis of the father and maternal grandfather of the proposita who happened to have the same mutation (Arg413Gln).
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Affiliation(s)
- Antonio Girolami
- Department of Medicine, University of Padua Medical School, Padua, Italy,
| | - Mariano Paoletti
- Hematologia Clinica, Universidad Fasta, Mar del Plata, Argentina
| | - Silvia Ferrari
- Department of Medicine, University of Padua Medical School, Padua, Italy
| | - Diana Garcia
- Bioquimica Clinica, Universidad Fasta, Mar del Plata, Argentina
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Aravalli RN, Collins DP, Hapke JH, Crane AT, Steer CJ. Hepatic Differentiation of Marmoset Embryonic Stem Cells and Functional Characterization of ESC-Derived Hepatocyte-Like Cells. Hepat Med 2020; 12:15-27. [PMID: 32104112 PMCID: PMC7026140 DOI: 10.2147/hmer.s243277] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 01/29/2020] [Indexed: 12/12/2022] Open
Abstract
Background Primary human hepatocytes (PHHs) are the ideal candidates for studying critical liver functions such as drug metabolism and toxicity. However, as they are isolated from discarded livers that are unsuitable for transplantation, they possess limited expansion ability in vitro and their enzymatic functions deteriorate rapidly because they are often of poor quality. Therefore, there is a compelling reason to find reliable alternative sources of hepatocytes. Methods In this study, we report on efficient and robust differentiation of embryonic stem cells (ESC) from the common marmoset Callithrix jacchus into functional hepatocyte-like cells (HLC) using a simple, and reproducible three-step procedure. ESC-derived HLCs were examined by morphological analysis and tested for their expression of hepatocyte-specific markers using a combination of immunohistochemistry, RT-PCR, and biochemical assays. Primary human hepatocytes were used as controls. Results ESC-derived HLCs expressed each of the hepatocyte-specific markers tested, including albumin; α-fetoprotein; asialoglycoprotein receptor 1; α-1 antitrypsin; hepatocyte nuclear factors 1α and 4; cytokeratin 18; hepatocyte growth factor receptor; transferrin; tyrosine aminotransferase; alkaline phosphatase; c-reactive protein; cytochrome P450 enzymes CYP1A2, CYP2E1 and CYP3A4; and coagulation factors FVII and FIX. They were functionally competent as demonstrated by biochemical assays in addition to producing urea. Conclusion Our data strongly suggest that marmoset HLCs possess characteristics similar to those of PHHs. They could, therefore, be invaluable for studies on drug metabolism and cell transplantation therapy for a variety of liver disorders. Because of the similarities in the anatomical and physiological features of the common marmoset to that of humans, Callithrix jacchus is an appropriate animal model to study human disease conditions and cellular functions.
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Affiliation(s)
- Rajagopal N Aravalli
- Department of Electrical and Computer Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | | | - Joel H Hapke
- Cytomedical Design Group LLC, St. Paul, MN 55127, USA
| | - Andrew T Crane
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Clifford J Steer
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA.,Department of Genetics, Cell Biology and Development, University of Minnesota, Minneapolis, MN 55455, USA
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Hasoon J, Rivers JM. A case of heterozygous factor VII deficiency in pregnancy. J OBSTET GYNAECOL 2019; 40:1025-1026. [PMID: 31795789 DOI: 10.1080/01443615.2019.1674792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jamal Hasoon
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
| | - Jose M Rivers
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
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Pomero F, Spadafora L, D'Agnano S, Dentali F, Fenoglio LM. Direct oral anticoagulants in factor VII deficiency patient. Intern Emerg Med 2019; 14:1353-1356. [PMID: 31529192 DOI: 10.1007/s11739-019-02186-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/26/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Fulvio Pomero
- U.O. Medicina Interna, Ospedale S. Lazzaro, Via P. Belli 26, 12051, Alba, Italy.
| | | | - Salvatore D'Agnano
- Specialty Training in Internal Medicine, University of Turin, Turin, Italy
| | - Francesco Dentali
- Department of Clinical Medicine, University of Insubria, Varese, Italy
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Andersen E, Chollet ME, Baroni M, Pinotti M, Bernardi F, Skarpen E, Sandset PM, Skretting G. The effect of the chemical chaperone 4-phenylbutyrate on secretion and activity of the p.Q160R missense variant of coagulation factor FVII. Cell Biosci 2019; 9:69. [PMID: 31467667 PMCID: PMC6712599 DOI: 10.1186/s13578-019-0333-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 08/17/2019] [Indexed: 01/09/2023] Open
Abstract
Background Congenital coagulation factor (F) VII deficiency is a rare bleeding disorder caused by mutations in the F7 gene. The missense factor FVII variant p.Q160R is the disease-causing mutation in all Norwegian FVII deficient patients and results in reduced biological activity and antigen levels of FVII in patient plasma. Previous in vitro studies on this variant demonstrated impaired intracellular trafficking and reduced secretion, possibly due to protein misfolding. The aim of the study was therefore to assess the impact of chemical chaperones on cellular processing and secretion of this variant using a cell model based on overexpression of the recombinant protein. Results Through screening of compounds, we identified 4-phenylbutyrate (4-PBA) to increase the secretion of recombinant (r) FVII-160R by ~ 2.5-fold. Additionally, treatment with 4-PBA resulted in a modest increase in specific biological activity. Intracellular localization studies revealed that upon treatment with 4-PBA, rFVII-160R was secreted through Golgi and Golgi reassembly-stacking protein (GRASP)-structures. Conclusions The present study demonstrates that the chemical chaperone 4-PBA, restores intracellular trafficking and increases the secretion of a missense FVII variant with functional properties in the extrinsic coagulation pathway.
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Affiliation(s)
- Elisabeth Andersen
- 1Department of Haematology, Oslo University Hospital, Oslo, Norway.,2Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,3Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Maria Eugenia Chollet
- 1Department of Haematology, Oslo University Hospital, Oslo, Norway.,2Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Marcello Baroni
- Department of Life Sciences and Biotechnology, and LTTA Centre, University of Ferrara, Oslo, Norway
| | - Mirko Pinotti
- Department of Life Sciences and Biotechnology, and LTTA Centre, University of Ferrara, Oslo, Norway
| | - Francesco Bernardi
- Department of Life Sciences and Biotechnology, and LTTA Centre, University of Ferrara, Oslo, Norway
| | - Ellen Skarpen
- 5Core Facility for Advanced Light Microscopy, Institute for Cancer Research, Oslo University Hospital, Ferrara, Italy
| | - Per Morten Sandset
- 1Department of Haematology, Oslo University Hospital, Oslo, Norway.,2Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,3Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Grethe Skretting
- 1Department of Haematology, Oslo University Hospital, Oslo, Norway.,2Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
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30
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Pongjantarasatian S, Kadegasem P, Sasanakul W, Sa-ngiamsuntorn K, Borwornpinyo S, Sirachainan N, Chuansumrit A, Tanratana P, Hongeng S. Coagulant activity of recombinant human factor VII produced by lentiviral human F7 gene transfer in immortalized hepatocyte-like cell line. PLoS One 2019; 14:e0220825. [PMID: 31381603 PMCID: PMC6681952 DOI: 10.1371/journal.pone.0220825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/23/2019] [Indexed: 11/19/2022] Open
Abstract
Human mesenchymal stem cells (hMSCs) have the potential to differentiate into hepatocyte-like cells, indicating that these cells may be the new target cell of interest to produce biopharmaceuticals. Our group recently established a hMSC-derived immortalized hepatocyte-like cell line (imHC) that demonstrates several liver-specific phenotypes. However, the ability of imHC to produce coagulation factors has not been characterized. Here, we examined the potential for imHC as a source of coagulation protein production by investigating the ability of imHC to produce human factor VII (FVII) using a lentiviral transduction system. Our results showed that imHC secreted a low amount of FVII (~22 ng/mL) into culture supernatant. Moreover, FVII from the transduced imHC (0.11 ± 0.005 IU/mL) demonstrated a similar coagulant activity compared with FVII from transduced HEK293T cells (0.12 ± 0.004 IU/mL) as determined by chromogenic assay. We demonstrate for the first time, to the best of our knowledge, that imHC produced FVII, albeit at a low level, indicating the unique characteristic of hepatocytes. Our study suggests the possibility of using imHC for the production of coagulation proteins.
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Affiliation(s)
| | - Praguywan Kadegasem
- Division of Hematology-Oncology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Werasak Sasanakul
- Division of Hematology-Oncology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Suparerk Borwornpinyo
- Department of Biotechnology, Faculty of Science, Mahidol University, Bangkok, Thailand
- Excellent Center for Drug Discovery, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Nongnuch Sirachainan
- Division of Hematology-Oncology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ampaiwan Chuansumrit
- Division of Hematology-Oncology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pansakorn Tanratana
- Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok, Thailand
- * E-mail:
| | - Suradej Hongeng
- Division of Hematology-Oncology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Heterozygous FXII deficiency is not associated with an increased incidence of thrombotic events: Results of a long term study. Blood Cells Mol Dis 2019; 77:8-11. [DOI: 10.1016/j.bcmd.2019.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 11/18/2022]
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Wang H, Wang L, Li S, Dong N, Wu Q. N-Glycan-calnexin interactions in human factor VII secretion and deficiency. Int J Biochem Cell Biol 2019; 113:67-74. [PMID: 31185295 DOI: 10.1016/j.biocel.2019.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/28/2019] [Accepted: 05/02/2019] [Indexed: 12/22/2022]
Abstract
Factor VII (FVII) is a key serine protease in blood coagulation. N-glycosylation in FVII has been shown to be critical for protein secretion. To date, however, the underlying biochemical mechanism remains unclear. Recently, we found that N-glycans in the transmembrane serine protease corin are critical for calnexin-assisted protein folding and extracellular expression. In this study, we tested the hypothesis that N-glycans in the FVII protease domain mediate calnexin-assisted protein folding and that naturally occurring F7 mutations abolishing N-glycosylation impair FVII secretion. We expressed human FVII wild-type (WT) and mutant proteins lacking one or both N-glycosylation sites in HEK293 and HepG2 cells in the presence or absence of a glucosidase inhibitor. FVII expression, secretion and binding to endoplasmic reticulum chaperones were examined by immune staining, co-immunoprecipitation, Western blotting, and ELISA. We found that N-glycosylation at N360 in the protease domain, but not N183 in the pro-peptide domain, of human FVII is required for protein secretion. Elimination of N-glycosylation at N360 impaired calnexin-assisted FVII folding and secretion. Similar results were observed in WT FVII when N-glycan-calnexin interaction was blocked by glucosidase inhibition. Naturally occurring F7 mutations abolishing N-glycosylation at N360 reduced FVII secretion in HEK293 and HepG2 cells. These results indicate that N-glycans in the FVII protease domain mediate calnexin-assisted protein folding and subsequent extracellular expression. Naturally occurring F7 mutations abolishing N-glycosylation in FVII may impair this mechanism, thereby reducing FVII levels in patients.
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Affiliation(s)
- Hao Wang
- From Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lina Wang
- The Cyrus Tang Hematology Center, Collaborative Innovation Center of Hematology, State Key Laboratory of Radiation Medicine and Prevention, Soochow University, Suzhou, China
| | - Shuo Li
- From Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ningzheng Dong
- The Cyrus Tang Hematology Center, Collaborative Innovation Center of Hematology, State Key Laboratory of Radiation Medicine and Prevention, Soochow University, Suzhou, China; MOH Key Laboratory of Thrombosis and Hemostasis, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qingyu Wu
- From Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; The Cyrus Tang Hematology Center, Collaborative Innovation Center of Hematology, State Key Laboratory of Radiation Medicine and Prevention, Soochow University, Suzhou, China.
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33
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Zaidi MH, Stanley A, Khan M. Acquired Factor VII deficiency - a rare but important consideration. Scott Med J 2019; 64:119-122. [PMID: 31142211 DOI: 10.1177/0036933019853167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Isolated acquired Factor VII deficiency is a rare coagulation disorder which is independent of vitamin K deficiency. The exact pathophysiological basis of this condition is unclear. We present a series of cases highlighting different clinical scenarios where this condition was encountered. CASE SERIES The first case presented with intra-abdominal sepsis. The second was a patient admitted with acute kidney injury and subsequently diagnosed with myeloma. The final case presented with microangiopathic haemolytic anaemia and was suspected of having atypical Haemolytic Uraemic Syndrome. In each case, there was no family or personal history of a bleeding disorder. Follow-up Factor VII levels after recovery from illness was normal in all three cases. CONCLUSION Acquired Factor VII deficiency is an uncommon but important finding which should be considered in the general medical setting when an isolated prolonged prothrombin time is detected.
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Affiliation(s)
| | - Arran Stanley
- 2 Foundation Doctor, Department of Haematology, Aberdeen Royal Infirmary, UK
| | - Mohammed Khan
- 3 Consultant Haematologist, Department of Haematology, Aberdeen Royal Infirmary, UK
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Girolami A, Cosi E, Ferrari S, Girolami B, Randi ML. Thrombotic Events in Homozygotes with a Proven or Highly Probable Arg304Gln Factor VII Mutation (FVII Padua)1): Only Limited Replacement Therapy is Needed in Case of Surgery. Cardiovasc Hematol Disord Drug Targets 2019; 19:233-238. [PMID: 30854979 DOI: 10.2174/1871529x19666190308114842] [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: 08/20/2018] [Revised: 01/31/2019] [Accepted: 02/14/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the prevalence of thrombotic events among patients with proven or highly probable homozygosis for the Arg304Gln (Factor VII Padua) defect or compound heterozygosis containing the Arg304Gln mutation. METHODS Homozygotes and compound heterozygotes proven by molecular studies to have the Arg304Gln mutation were gathered from personal files and from two PubMed searches. In addition, patients with probable homozygosis on the basis of clotting tests (discrepancies among Factor VII activity levels according to the tissue thromboplastin used) were also gathered. RESULTS 30 proven homozygotes and 17 probable ones were gathered together with 8 compound heterozygotes. In the latter use, the associated mutation was Cys135Arg (twice), Gly180Arg, Arg304Trp, Arg315Trp, His348Gln, Gly365Cys. The prevalence of venous thrombotic events was 16.6, 11.8 and 11.1 percent, respectively for the three groups of patients. Heterozygotes showed no thrombotic event. The difference for proven homozygotes was statistically significant, while for the other groups only a trend was present. CONCLUSION proven homozygous or compound heterozygous patients with the Arg304Gln mutation showed a higher than expected incidence of thrombotic events. The same is true for probable cases gathered only on the basis of clotting tests. These patients, because of their frequent lack of bleeding and for their relatively high prevalence of thrombosis should probably receive only limited replacement therapy in case of surgical procedures.
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Affiliation(s)
- Antonio Girolami
- Department of Medicine, University of Padua Medical School, Padua, Italy
| | - Elisabetta Cosi
- Department of Medicine, University of Padua Medical School, Padua, Italy
| | - Silvia Ferrari
- Department of Medicine, University of Padua Medical School, Padua, Italy
| | | | - Maria L Randi
- Department of Medicine, University of Padua Medical School, Padua, Italy
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Wool GD. Benefits and Pitfalls of Point-of-Care Coagulation Testing for Anticoagulation Management: An ACLPS Critical Review. Am J Clin Pathol 2019; 151:1-17. [PMID: 30215666 DOI: 10.1093/ajcp/aqy087] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objectives Point-of-care (POC) testing is generally less precise and has higher reagent costs per test than laboratory-based assays. However, POC hemostasis testing can offer significant advantages in particular situations: patient-managed warfarin therapy as well as rapid turnaround time heparin management for intraoperative patients. Of note, POC hemostasis testing is generally approved for the purposes of anticoagulation monitoring and is inferior to laboratory coagulation testing for the diagnosis of congenital or acquired coagulopathy. Methods The frequently used POC coagulation instruments for POC international normalized ratio and activated clotting time are reviewed, as well as their typical performance relative to central laboratory testing (where available). Results Several cases are discussed that highlight the benefits, as well as pitfalls, of POC coagulation testing. Conclusions POC coagulation testing for anticoagulation monitoring offers advantages in particular situations. Clear policies and protocols must be developed to guide proper use of POC versus central laboratory hemostasis testing.
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Affiliation(s)
- Geoffrey D Wool
- The Department of Pathology, University of Chicago, Chicago, IL
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36
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Girolami A, de Paoletti DNG, Nenkies ML, Ferrari S, Guglielmone H. Factor X Deficiency Due to a Compound Heterozygosis Between a New Mutation (Gla72Asp) in Exon 2 and an Already Known one (Gly154Arg) in Exon 5: Factor X Mar Del Plata1). Cardiovasc Hematol Disord Drug Targets 2018; 19:169-173. [PMID: 30539705 DOI: 10.2174/1871529x19666181212103944] [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: 04/20/2018] [Revised: 11/07/2018] [Accepted: 11/30/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Investigation of rare bleeding disorders in Latin-America. OBJECTIVES The report of a new case of FX deficiency due to a compound heterozygosis. METHODS Accepted clotting procedures were used. Sequencing of DNA was carried out by means of Applied Biosystems Instruments. RESULTS A compound heterozygote due to the association of a new mutation (Gla72Asp) with an already known mutation (Gly154Arg) of the FX gene is reported. The proposita is a 38 year old female who had a moderate bleeding tendency (menorrhagia, epistaxis, easy bruising). The proposita has never received substitution therapy but in the occasion of a uterine biopsy. The mother was asymptomatic but was a heterozygote for the new mutation. The father was asymptomatic but had deserted the family and could not be investigated. After this abandonment the mother of the proposita re-married with an asymptomatic man and she gave birth to a son who was asymptomatic but was also heterozygous for the new mutation (Gla72Asp). As a consequence it has to be assumed that the first husband of the mother of the proposita was heterozygous for the known mutation (Gly154Arg). CONCLUSIONS This is the third case of a new mutation in the FX gene reported, during the past few years, in Argentina.
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Affiliation(s)
| | | | | | - Silvia Ferrari
- Department of Medicine, Padua Medical School, Padua, Italy
| | - Hugo Guglielmone
- Laboratorio de Hematologia, Sanatorio Allende y Departamento de Bioquimica Clinica, Facultad de Ciencias Quimicas, Universidad Nacional de Cordoba, Cordoba, Argentina
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Girolami A, Ferrari S, Cosi E, Santarossa C, Randi ML. Vitamin K-Dependent Coagulation Factors That May be Responsible for Both Bleeding and Thrombosis (FII, FVII, and FIX). Clin Appl Thromb Hemost 2018; 24:42S-47S. [PMID: 30428703 PMCID: PMC6714837 DOI: 10.1177/1076029618811109] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Vitamin K-dependent clotting factors are commonly divided into prohemorrhagic
(FII, FVII, FIX, and FX) and antithrombotic (protein C and protein S).
Furthermore, another protein (protein Z) does not seem strictly correlated with
blood clotting. As a consequence of this assumption, vitamin K-dependent defects
were considered as hemorrhagic or thrombotic disorders. Recent clinical
observations, and especially, recent advances in molecular biology
investigations, have demonstrated that this was incorrect. In 2009, it was
demonstrated that the mutation Arg338Leu in exon 8 of FIX was associated with
the appearance of a thrombophilic state and venous thrombosis. The defect was
characterized by a 10-fold increased activity in FIX activity, while FIX antigen
was only slightly increased (FIX Padua). On the other hand, it was noted on
clinical grounds that the thrombosis, mainly venous, was present in about 2% to
3% of patients with FVII deficiency. It was subsequently demonstrated that 2
mutations in FVII, namely, Arg304Gln and Ala294Val, were particularly affected.
Both these mutations are type 2 defects, namely, they show low activity but
normal or near-normal FVII antigen. More recently, in 2011-2012, it was noted
that prothrombin defects due to mutations of Arg596 to Leu, Gln, or Trp in exon
15 cause the appearance of a dysprothrombinemia that shows no bleeding tendency
but instead a prothrombotic state with venous thrombosis. On the contrary, no
abnormality of protein C or protein S has been shown to be associated with
bleeding rather than with thrombosis. These studies have considerably widened
the spectrum and significance of blood coagulation studies.
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Affiliation(s)
- Antonio Girolami
- Department of Medicine, University of Padua Medical School, Padua, Italy
| | - Silvia Ferrari
- Department of Medicine, University of Padua Medical School, Padua, Italy
| | - Elisabetta Cosi
- Department of Medicine, University of Padua Medical School, Padua, Italy
| | - Claudia Santarossa
- Department of Medicine, University of Padua Medical School, Padua, Italy
| | - Maria Luigia Randi
- Department of Medicine, University of Padua Medical School, Padua, Italy
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38
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Sun Y, Jia L, Yang Z, Chen W. A new perspective on perioperative coagulation management in a patient with congenital factor VII deficiency: A case report. Medicine (Baltimore) 2018; 97:e12776. [PMID: 30383632 PMCID: PMC6221632 DOI: 10.1097/md.0000000000012776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Congenital factor VII (FVII) deficiency is a rare coagulopathy. There are little clinical data for congenital FVII deficiency and no evidence-based medicine guidelines for treatment. PATIENT CONCERNS A 48-year-old woman with gallbladder stones suffered from intermittent abdominal pain for 2 months that was accompanied by an abnormally prolonged prothrombin time. DIAGNOSES The woman was diagnosed as having cholecystolithiasis with cholecystitis and congenital FVII deficiency. INTERVENTION Preoperative evaluation confirmed the necessity of recombinant activated factor VII (rFVIIa) replacement therapy. We monitored the plasma factor VII activity (FVII:C) and coagulation function, determined the half-life of rFVIIa in the patient, and administered personalized rFVIIa replacement therapy. OUTCOMES Laparoscopic cholecystectomy was performed successfully, and the patient recovered well without any complications. LESSONS The clinical manifestations and severity of bleeding in patients with congenital FVII deficiency can vary widely. The history of massive bleeding and plasma FVII:C are the decisive factors when implementing a replacement therapy. The actual half-life of rFVIIa can be determined from intensive monitoring results of plasma FVII:C at the beginning of replacement therapy, which could further guide the personalization of rFVIIa replacement therapy.
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Affiliation(s)
- Yongliang Sun
- Department of General Surgery, China-Japan Friendship Hospital
| | - Lingling Jia
- Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Zhiying Yang
- Department of General Surgery, China-Japan Friendship Hospital
| | - Wenqian Chen
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China
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Homozygous congenital factor VII deficiency with a novel mutation, associated with severe spontaneous intracranial bleeding in a neonate. Blood Coagul Fibrinolysis 2018; 29:476-480. [PMID: 29916836 DOI: 10.1097/mbc.0000000000000748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Herein, a neonate with congenital FVII deficiency is presented. BASIC METHOD Diagnosis of congenital FVII deficiency was confirmed by genetic analysis using next-generation sequencing method (MiSeq-Illumina). RESULT Our patient was found to have a novel homozygous mutation. CONCLUSION Early diagnosis and treatment of congenital FVII deficiency can be crucial.
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Nguyen AL, Kamal M, Raghavan R, Nagaraj G. Acquired factor VII deficiency causing severe bleeding disorder secondary to AL amyloidosis of the liver. Hematol Rep 2018; 10:7235. [PMID: 30344985 PMCID: PMC6176396 DOI: 10.4081/hr.2018.7235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 06/29/2018] [Indexed: 11/23/2022] Open
Abstract
A 52 year-old male presented with neck pain after undergoing thyroidectomy for a goiter three weeks prior which was complicated by a neck hematoma requiring evacuation. Computed tomography (CT) scan showed a neck hematoma requiring evacuation and he received desmopressin with cessation of bleeding. Coagulation studies were normal. He returned eighteen months later with severe oral mucosal bleeding after a dental procedure and required transfusions with red blood cells, platelets, and fresh frozen plasma (FFP) in addition to desmopressin, Humate-P, aminocaproic acid, and surgical packing. A comprehensive bleeding diathesis workup was normal. He was readmitted six months later due to abdominal pain and distention and found to have massive hepatosplenomegaly on CT. A new coagulopathy workup revealed prolonged INR to 1.5, corrected prothrombin time mixing study, and a low factor VII level (29%), suggesting acquired factor VII deficiency. A transjugular liver biopsy revealed extensive involvement by ALamyloidosis- Kappa type. He then developed a large right retroperitoneal hematoma which required multiple transfusions with FFP, cryoprecipitate, aminocaproic acid, and vitamin K with slight success. Hemorrhage was subsequently stabilized with recombinant factor VIIa administered every four hours which corresponded with correction of factor VII levels and PT and eventual cessation hemorrhage. Acquired factor VII deficiency causing severe coagulopathy was attributed to hepatic amyloidosis ALkappa subtype. We started treatment with bortezomib, dexamethasone, and cyclophosphamide, however, the patient succumbed to uncontrolled hemorrhage. Acquired factor VII deficiency is extremely rare and to our knowledge, this is the only known case of factor VII deficiency secondary to amyloidosis involving the liver.
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Affiliation(s)
| | | | - Ravi Raghavan
- Department of Pathology and Human Anatomy, Loma Linda University Medical Center, Loma Linda, CA, USA
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Tripathi P, Mishra P, Ranjan R, Tyagi S, Seth T, Saxena R. Factor VII deficiency - an enigma; clinicohematological profile in 12 cases. ACTA ACUST UNITED AC 2018; 24:97-102. [PMID: 30191763 DOI: 10.1080/10245332.2018.1518799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Factor VII deficiency is the commonest of the rare bleeding disorders with limited knowledge on clinical profile. The objective of this study was to study the prevalence and clinico-hematological profile of factor VII-deficient patients. METHODS It is a retrospective observational study of probable inherited factor VII deficiency covering 18 months. Their clinical profile, family history, investigation and treatment records were studied in detail. RESULTS The study group comprised of total 12 factor VII deficiency cases with mean age of 17.5 years of onset of symptoms. The commonest symptom was menorrhagia (41.6%) followed by epistaxis (25%) and easy bruisability (16.6%). These 12 patients when categorized according to bleeding severity: severe bleeding - 2, moderate bleeding - 3, mild bleeding - 6 and asymptomatic - 1. All cases had prolonged prothrombin time (PT) with mean PT of 35.4 seconds (range 18-50 seconds) and mean prolongation of PT from upper limit of normal - 19.4 seconds (range 2-34 seconds). Factor VII levels ranged from < 1-40% in these patients. Clinical symptoms were not in concordance with factor levels. Of 12 patients, required treatment other than local measures. DISCUSSION AND CONCLUSION Inherited factor VII deficiency is the commonest autosomally inherited factor deficiency with marked variation in the age of presentation and clinical symptoms. The laboratory results in form of PT and factor VII levels do not correlate with the severity of clinical presentation. A comprehensive evaluation to exclude acquired causes of factor VII deficiency, e.g. obesity, liver diseases, vitamin K deficiency and acquired inhibitors is required before labeling it as inherited in the absence of family history and molecular studies.
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Affiliation(s)
- Preeti Tripathi
- a Department of Hematology , All India Institute of Medical Sciences , New Delhi , India
| | - Priyanka Mishra
- a Department of Hematology , All India Institute of Medical Sciences , New Delhi , India
| | - Ravi Ranjan
- a Department of Hematology , All India Institute of Medical Sciences , New Delhi , India
| | - Seema Tyagi
- a Department of Hematology , All India Institute of Medical Sciences , New Delhi , India
| | - Tulika Seth
- a Department of Hematology , All India Institute of Medical Sciences , New Delhi , India
| | - Renu Saxena
- a Department of Hematology , All India Institute of Medical Sciences , New Delhi , India
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De D, Nayak HK, Datta SS, Islam N, Halder S. Pediatric cardiac intervention in a case of congenital factor VII deficiency: a challenge to overcome. Indian J Hematol Blood Transfus 2018; 34:191-193. [PMID: 29398832 DOI: 10.1007/s12288-017-0837-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- Dibyendu De
- 1Department of Clinical Hematology, The Mission Hospital, Sector-2C, Immon Kalyan Sarani, Bidhannagar, Durgapur, West Bengal 713212 India
| | - Hemant Kumar Nayak
- 2Department of Pediatric Cardiology, The Mission Hospital, Durgapur, West Bengal India
| | - Suvro Sankha Datta
- 3Department of Transfusion Medicine, The Mission Hospital, Durgapur, West Bengal India
| | - Nurul Islam
- 2Department of Pediatric Cardiology, The Mission Hospital, Durgapur, West Bengal India
| | - Sandeepan Halder
- 4Department of Pathology, The Mission Hospital, Durgapur, West Bengal India
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McQuerry JL, Burnham JM, Ireland ML, Wright RD. Delayed Presentation of Compartment Syndrome of the Thigh in a Previously Undiagnosed Factor VII-Deficient High School Football Athlete: A Case Report. JBJS Case Connect 2018; 8:e4. [PMID: 29369058 DOI: 10.2106/jbjs.cc.17.00123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE We describe a case of delayed presentation of compartment syndrome in the anterior aspect of the thigh in a high school athlete. The patient had sustained a blow to the thigh 8 days prior to presentation, and had continued to practice football in the setting of undiagnosed coagulopathy. He presented with severe thigh pain and the inability to contract the thigh muscles. CONCLUSION A high index of suspicion for compartment syndrome is indicated for patients with disproportionate pain, especially in the setting of relatively minor trauma. Underlying coagulopathy should be investigated in patients with compartment syndrome because there is a high incidence of bleeding disorders in this population.
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Affiliation(s)
- Jessica L McQuerry
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky Medical Center, Lexington, Kentucky
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A novel factor X mutation Cys81 by Arg and a reported factor VII polymorphism Arg353 replaced by Gln co-occured in a patient. Blood Coagul Fibrinolysis 2017; 29:67-74. [PMID: 29251640 DOI: 10.1097/mbc.0000000000000691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: Coagulation factor X and factor VII (FVII) are both very important components in blood coagulation. To study the molecular pathogenic mechanism of the inherited factor X and FVII deficiency, the factor X activity (FX:C) and FVII activity were tested with one-stage clotting methods. The factor X antigen and factor FVII antigen were tested with ELISA. All the exons, intron-exon boundaries and 5',3'-flanking regions of F10 and F7 genes were amplified by PCR with direct sequencing. The ClustalX software was used to analyze the conservative property of the mutation sites. The PolyPhen-2 and Sorting Intolerant From Tolerant (SIFT) online bioinformatics softwares were taken to predict whether the point mutation could affect protein function. The software Swiss-pdb Viewer was brought to analyze the impact of mutations on the structure and function of the protein. The thrombin generation tests were applied to evaluate whether there were obstacles in producing thrombin about the mutant protein. The FX:C and FVII activity of the proband were reduced to 35 and 42%, and the factor X antigen and factor FVII antigen were decreased to 43 and 55%, simultaneously. Correspondingly, a FX:Cys81Arg (Cys81 by Arg) mutation and a FVII:Arg353 replaced by Gln polymorphism were detected in the proband. The Cys81 of factor X was conserved among homologous species, but the Arg353 of FVII was not. All softwares analysis results indicated protein features and structures might be affected by the mutation and the polymorphism. And the thrombin generation tests showed that the mutant protein had obstacles in thrombin generation. We identified a FX:Cys81Arg mutation and a FVII:Arg353 replaced by Gln polymorphism in the proband. And they accounted for the decrease of the activity and antigen of factor X and FVII. Of note, the Cys81Arg of factor X was first reported in the world.
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Dolce A, Mariani G, Di Minno MN. Bleeding symptoms at disease presentation and prediction of ensuing bleeding in inherited FVII deficiency. Thromb Haemost 2017; 109:1051-9. [DOI: 10.1160/th12-10-0740] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 03/03/2013] [Indexed: 11/05/2022]
Abstract
SummaryIndividuals with inherited factor VII (FVII) deficiency display bleeding phenotypes ranging from mild to severe, with 30% of patients having always been asymptomatic (non-bleeding). In 626 FVII-deficient individuals, by analysing data from the International Factor VII (IF7) Registry and the Seven Treatment Evaluation Registry (STER), we determined whether bleeding type at disease presentation and FVII coagulant activity (FVIIc) predict ensuing bleeds. At disease presentation/diagnosis, 272 (43.5%) individuals were non-bleeding, 277 (44.2%) had minor bleeds, and 77 (12.3%) had major bleeds. During a median nine-year index period (IP) observation, 87.9% of non-bleeding individuals at presentation remained asymptomatic, 75.1% of minor-bleeders had new minor bleeds, and 83.1% of major-bleeders experienced new major bleeds. After adjusting for FVIIc levels and other clinical and demographic variables, the relative risk (RR) for ensuing bleedings during the IP was 6.02 (p <0.001) and 5.87 (p <0.001) in individuals presenting with major and minor bleeds, respectively. Conversely, compared to non-bleeding individuals, a 10.95 (p = 0.001) and 28.21 (p <0.001) RR for major bleedings during the IP was found in those with minor and with major bleeds at presentation, respectively. In conclusion, in FVII deficiency, the first major bleeding symptom is an independent predictor of the risk of subsequent major bleeds.
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Di Minno MND, Napolitano M, Dolce A, Mariani G. Role of clinical and laboratory parameters for treatment choice in patients with inherited FVII deficiency undergoing surgical procedures: evidence from the STER registry. Br J Haematol 2017; 180:563-570. [PMID: 29235093 DOI: 10.1111/bjh.15055] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/09/2017] [Indexed: 11/30/2022]
Abstract
Perioperative bleeding is a major concern in patients with factor VII (FVII) deficiency. Evaluating data of 95 FVII-deficient patients undergoing 110 surgical procedures (61 major, 49 minor), we assessed the impact of type of surgery, bleeding phenotype and FVII coagulant activity (FVII:C) levels on perioperative replacement therapy (RT). Compared to those with higher FVII:C levels, patients with <3% FVII:C received a higher number of RT doses (8 vs. 2, P = 0·003) for a longer RT duration (3 days vs. 1 day, P = 0·001), with no difference in RT dose. Similarly, patients with a history of major bleeds received a higher number of RT doses (8·5 vs. 2-3, P = 0·013) for a longer RT duration (2 days vs. 1 day, P = 0·005) as compared to those with a history of minor bleeds or to asymptomatic patients. No difference in RT was found among major and minor surgical procedures. Overall, multivariate analysis showed that history of major bleeding was the only independent predictor of number of RT doses (β = 0·352, P = 0·001) and RT duration (β = 0·405, P = 0·018). Overall, a ≈20 μg/kg perioperative RT was efficacious in 95·5% of cases. The infusion should be repeated ≈8 times in high-risk subsets (i.e. patients with a history of major bleeding).
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Affiliation(s)
- Matteo N D Di Minno
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Mariasanta Napolitano
- Haematology Unit, Thrombosis and Hemostasis Reference Regional Center, University of Palermo, Palermo, Italy
| | | | - Guglielmo Mariani
- Faculty of Science and Technology, University of Westminster, London, UK
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Bleeding manifestations in heterozygotes with prothrombin deficiency or abnormalities vs. unaffected family members as observed during a long follow-up study. Blood Coagul Fibrinolysis 2017; 28:623-626. [DOI: 10.1097/mbc.0000000000000648] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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48
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Tiscia G, Favuzzi G, Chinni E, Colaizzo D, Fischetti L, Intrieri M, Margaglione M, Grandone E. Factor VII deficiency: a novel missense variant and genotype-phenotype correlation in patients from Southern Italy. Hum Genome Var 2017; 4:17048. [PMID: 29104756 PMCID: PMC5667183 DOI: 10.1038/hgv.2017.48] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/23/2017] [Accepted: 09/10/2017] [Indexed: 11/17/2022] Open
Abstract
This study aimed at attempting to correlate genotype and phenotype in factor VII deficiency. Here, we present molecular and clinical findings of 10 patients with factor VII deficiency. From 2013 to 2016, 10 subjects were referred to our center because of a prolonged prothrombin time identified during routine or presurgery examinations or after a laboratory assessment of a bleeding episode. Mutation characterization was performed using the bioinformatics applications PROMO, SIFT, and Polyphen-2. Structural changes in the factor VII protein were analyzed using the SPDB viewer tool. Of the 10 variants we identified, 1 was responsible for a novel missense change (c.1199G>C, p.Cys400Ser); in 2 cases we identified the c.-54G>A and c.509G>A (p.Arg170His) polymorphic variants in the 5′-upstream region of the factor VII gene and exon 6, respectively. To our knowledge, neither of these polymorphic variants has been described previously in factor VII-deficient patients. In silico predictions showed differences in binding sites for transcription factors caused by the c.-54G>A variant and a probable damaging effect of the p.Cys400Ser missense change on factor VII active conformation, leading to breaking of the Cys400-Cys428 disulfide bridge. Our findings further suggest that, independently of factor VII levels and of variants potentially affecting factor VII levels, environmental factors, e.g., trauma, could heavily influence the clinical phenotype of factor VII-deficient patients.
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Affiliation(s)
- Giovanni Tiscia
- Atherosclerosis and Thrombosis Unit, I.R.C.C.S. 'Casa Sollievo della Sofferenza', San Giovanni Rotondo (Foggia), Italy
| | - Giovanni Favuzzi
- Atherosclerosis and Thrombosis Unit, I.R.C.C.S. 'Casa Sollievo della Sofferenza', San Giovanni Rotondo (Foggia), Italy
| | - Elena Chinni
- Atherosclerosis and Thrombosis Unit, I.R.C.C.S. 'Casa Sollievo della Sofferenza', San Giovanni Rotondo (Foggia), Italy
| | - Donatella Colaizzo
- Atherosclerosis and Thrombosis Unit, I.R.C.C.S. 'Casa Sollievo della Sofferenza', San Giovanni Rotondo (Foggia), Italy
| | - Lucia Fischetti
- Atherosclerosis and Thrombosis Unit, I.R.C.C.S. 'Casa Sollievo della Sofferenza', San Giovanni Rotondo (Foggia), Italy
| | - Mariano Intrieri
- Department of Medicine and Health Sciences 'Vincenzo Tiberio', University of Molise, Campobasso, Italy
| | | | - Elvira Grandone
- Atherosclerosis and Thrombosis Unit, I.R.C.C.S. 'Casa Sollievo della Sofferenza', San Giovanni Rotondo (Foggia), Italy
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Quintavalle G, Riccardi F, Rivolta GF, Martorana D, Di Perna C, Percesepe A, Tagliaferri A. F7 gene variants modulate protein levels in a large cohort of patients with factor VII deficiency. Results from a genotype-phenotype study. Thromb Haemost 2017; 117:1455-1464. [PMID: 28447100 DOI: 10.1160/th17-02-0085] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/10/2017] [Indexed: 12/14/2022]
Abstract
Congenital factor VII (FVII) deficiency is a rare bleeding disorder caused by mutations in F7 gene with autosomal recessive inheritance. A clinical heterogeneity with poor correlation with FVII:C levels has been described. It was the objective of this study to identify genetic defects and to evaluate their relationships with phenotype in a large cohort of patients with FVII:C<50 %. One hundred twenty-three probands were genotyped for F7 mutations and three polymorphic variants and classified according to recently published clinical scores. Forty out of 123 patients (33 %) were symptomatic (43 bleedings). A severe bleeding tendency was observed only in patients with FVII:C<0.10 %. Epistaxis (11 %) and menorrhagia (32 % of females in fertile age) were the most frequent bleedings. Molecular analysis detected 48 mutations, 20 not reported in the F7 international databases. Most mutations (62 %) were missense, large deletions were 6.2 %. Compound heterozygotes/homozygotes for mutations presented lower FVII:C levels compared to the other classes (Chi2=43.709, p<0,001). The polymorphisms distribution was significantly different among the three F7 genotypic groups (Chi2=72.289, p<0,001). The presence of truncating mutations was associated with lowest FVII:C levels (Chi2=21.351, p=0.002). This study confirms the clinical and molecular variability of the disease and the type of symptoms. It shows a good correlation between the type of F7 mutation and/or polymorphisms and FVII:C levels, without a direct link between FVII:C and bleeding tendency. The results suggest that large deletions are underestimated and that they represent a common mechanism of F7 gene inactivation which should always be investigated in the diagnostic testing for FVII deficiency.
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Affiliation(s)
- Gabriele Quintavalle
- Gabriele Quintavalle, Regional Reference Centre for inherited bleeding disorders, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy, Tel.: +39 0521 703971, Fax: +39 0521 704332, E-mail:
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Factor VII Deficiency: Clinical Phenotype, Genotype and Therapy. J Clin Med 2017; 6:jcm6040038. [PMID: 28350321 PMCID: PMC5406770 DOI: 10.3390/jcm6040038] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/12/2017] [Accepted: 03/23/2017] [Indexed: 12/14/2022] Open
Abstract
Factor VII deficiency is the most common among rare inherited autosomal recessive bleeding disorders, and is a chameleon disease due to the lack of a direct correlation between plasma levels of coagulation Factor VII and bleeding manifestations. Clinical phenotypes range from asymptomatic condition—even in homozygous subjects—to severe life-threatening bleedings (central nervous system, gastrointestinal bleeding). Prediction of bleeding risk is thus based on multiple parameters that challenge disease management. Spontaneous or surgical bleedings require accurate treatment schedules, and patients at high risk of severe hemorrhages may need prophylaxis from childhood onwards. The aim of the current review is to depict an updated summary of clinical phenotype, laboratory diagnosis, and treatment of inherited Factor VII deficiency.
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