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Manieri VM, Offidani M, Capelli D, Marzioni M, Maroni L, Filosa A, Rupoli S, Morsia E, Poloni A, Morè S. Hepatic, gastric and bone marrow AL amyloidosis that began with Budd-Chiari syndrome: a case report. Ann Hematol 2024; 103:3783-3786. [PMID: 38871930 DOI: 10.1007/s00277-024-05837-2] [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: 12/05/2023] [Accepted: 06/06/2024] [Indexed: 06/15/2024]
Abstract
Amyloid Light Chain (AL) Amyloidosis is a rare disorder of protein misfolding and metabolism characterized by insoluble fibrils deposition in various tissues and organs, which could quickly progress and become fatal. The most frequently affected organ is heart being its involvement the most adverse prognostic feature. Kidney and liver could be other organ localizations, defining AL Amyloidosis as a multisystem disorder. Being Budd-Chiari syndrome (BCS) an uncommon congestive hepatopathy caused by blockage of hepatic veins in the absence of cardiac disorders, it could be rarely caused by a massive deposition of amyloid proteins into hepatic sinusoidal spaces, giving an uncommon clinical presentation of AL Amyloidosis.
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Affiliation(s)
| | - Massimo Offidani
- Clinica di Ematologia, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Debora Capelli
- Clinica di Ematologia, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Marco Marzioni
- Clinica di Gastroenterologia, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
- Università Politecnica delle Marche, Facoltà Medicina e Chirurgia, Ancona, Italia
| | - Luca Maroni
- Clinica di Gastroenterologia, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Alessandra Filosa
- Anatomia Patologica, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Serena Rupoli
- Clinica di Ematologia, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Erika Morsia
- Clinica di Ematologia, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Antonella Poloni
- Clinica di Ematologia, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Sonia Morè
- Clinica di Ematologia, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy.
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2
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Verhenne S, McCluskey G, Maynadié H, Adam F, Casari C, Panicot-Dubois L, Crescence L, Dubois C, Denis CV, Lenting PJ, Christophe OD. Fitusiran reduces bleeding in factor X-deficient mice. Blood 2024; 144:227-236. [PMID: 38620079 DOI: 10.1182/blood.2023023404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/15/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024] Open
Abstract
ABSTRACT Factor X (FX) deficiency is a rare bleeding disorder manifesting a bleeding tendency caused by low FX activity levels. We aim to explore the use of fitusiran (an investigational small interfering RNA that silences antithrombin expression) to increase thrombin generation and the in vivo hemostatic potential under conditions of FX deficiency. We therefore developed a novel model of inducible FX deficiency, generating mice expressing <1% FX activity and antigen (f10low mice). Compared with control f10WT mice, f10low mice had sixfold and fourfold prolonged clotting times in prothrombin time and activated partial prothrombin time assays, respectively (P < .001). Thrombin generation was severely reduced, irrespective of whether tissue factor or factor XIa was used as an initiator. In vivo analysis revealed near-absent thrombus formation in a laser-induced vessel injury model. Furthermore, in 2 distinct bleeding models, f10low mice displayed an increased bleeding tendency compared with f10WT mice. In the tail-clip assay, blood loss was increased from 12 ± 16 μL to 590 ± 335 μL (P < .0001). In the saphenous vein puncture (SVP) model, the number of clots generated was reduced from 19 ± 5 clots every 30 minutes for f10WT mice to 2 ± 2 clots every 30 minutes (P < .0001) for f10low mice. In both models, bleeding was corrected upon infusion of purified FX. Treatment of f10low mice with fitusiran (2 × 10 mg/kg at 1 week interval) resulted in 17 ± 6% residual antithrombin activity and increased thrombin generation (fourfold and twofold to threefold increase in endogenous thrombin potential and thrombin peak, respectively). In the SVP model, the number of clots was increased to 8 ± 6 clots every 30 minutes (P = .0029). Altogether, we demonstrate that reduction in antithrombin levels is associated with improved hemostatic activity under conditions of FX deficiency.
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Affiliation(s)
- Sebastien Verhenne
- Université Paris-Saclay, INSERM, Hémostase Inflammation Thrombose HITh U1176, Le Kremlin-Bicêtre, France
| | - Geneviève McCluskey
- Université Paris-Saclay, INSERM, Hémostase Inflammation Thrombose HITh U1176, Le Kremlin-Bicêtre, France
| | - Hortense Maynadié
- Université Paris-Saclay, INSERM, Hémostase Inflammation Thrombose HITh U1176, Le Kremlin-Bicêtre, France
- Centre de Référence de l'Hémophilie et des Maladies Hémorragiques Constitutionnelles rares, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Frédéric Adam
- Université Paris-Saclay, INSERM, Hémostase Inflammation Thrombose HITh U1176, Le Kremlin-Bicêtre, France
| | - Caterina Casari
- Université Paris-Saclay, INSERM, Hémostase Inflammation Thrombose HITh U1176, Le Kremlin-Bicêtre, France
| | - Laurence Panicot-Dubois
- Aix Marseille Université, Center for Cardiovascular and Nutrition Research, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement 1260, INSERM U1263, Marseille, France
| | - Lydie Crescence
- Aix Marseille Université, Center for Cardiovascular and Nutrition Research, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement 1260, INSERM U1263, Marseille, France
| | - Christophe Dubois
- Aix Marseille Université, Center for Cardiovascular and Nutrition Research, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement 1260, INSERM U1263, Marseille, France
| | - Cécile V Denis
- Université Paris-Saclay, INSERM, Hémostase Inflammation Thrombose HITh U1176, Le Kremlin-Bicêtre, France
| | - Peter J Lenting
- Université Paris-Saclay, INSERM, Hémostase Inflammation Thrombose HITh U1176, Le Kremlin-Bicêtre, France
| | - Olivier D Christophe
- Université Paris-Saclay, INSERM, Hémostase Inflammation Thrombose HITh U1176, Le Kremlin-Bicêtre, France
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3
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Chigateri S, Jain A, Oli AK, Katti Sathyasheelappa SK. Factor X deficiency and pregnancy. BMJ Case Rep 2024; 17:e259458. [PMID: 38960427 DOI: 10.1136/bcr-2023-259458] [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] [Indexed: 07/05/2024] Open
Abstract
Factor X (FX) is a vitamin K-dependent enzyme, which acts as an important coagulation factor of coagulation cascade. FX deficiency is an autosomal recessive inherited disease and is often demonstrated in families with consanguity. Pregnancy in women with congenital FX deficiency has been associated with adverse fetal outcomes. We report a case of pregnancy in women with FX deficiency. The patient needed an immediate caesarean section at 38 weeks of gestation because of severe oligohydramnios and fetal distress. FX deficiency during pregnancy was effectively managed, leading to a positive outcome through the optimal utilisation of available resources.
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Affiliation(s)
- Seema Chigateri
- Obstetrics and Gynecology Department, SDM College of Medical Sciences and Hospital Shri Dharmasthala Manjunatheshwara University Sattur, Dharwad, Karnataka, India
| | - Apoorva Jain
- SDM Research Institute for Biomedical Sciences, Shri Dharmasthala Manjunatheshwara University Sattur, Dharwad, Karnataka, India
| | - Ajay Kumar Oli
- SDM Research Institute for Biomedical Sciences, Shri Dharmasthala Manjunatheshwara University Sattur, Dharwad, Karnataka, India
| | - Sunil Kumar Katti Sathyasheelappa
- Obstetrics and Gynecology Department, SDM College of Medical Sciences and Hospital Shri Dharmasthala Manjunatheshwara University Sattur, Dharwad, Karnataka, India
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4
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Coussee A, Alliet G, Hervent AS, Vynckier L, Emmerechts J, Van Hecke S, Persijn L. Acquired factor X deficiency in a multiple myeloma without amyloidosis: a case report. Acta Clin Belg 2023; 78:524-528. [PMID: 37800976 DOI: 10.1080/17843286.2023.2265650] [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: 08/07/2023] [Accepted: 09/21/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Multiple myeloma is one of the most common hematologic malignancies. Acquired factor X deficiencies are often observed in primary (AL) amyloidosis and rarely in multiple myeloma. OBJECTIVE We report a case of an acquired factor X deficiency in a patient with a newly diagnosed IgA lambda multiple myeloma, without any evidence of concomitant amyloidosis. METHODS We present the patient's medical history, clinical and physical examinations, laboratory analysis, and outcome. RESULTS A 76-year-old male presented at the emergency department with ongoing gingival bleeding. Several analytical problems with blood sample analysis arose, which eventually led to the diagnosis of a multiple myeloma. Further exploration revealed an acquired factor X deficiency, explaining the ongoing bleeding. There was no evidence of concomitant amyloidosis. The multiple myeloma was treated, leading to complete remission of the malignancy and bleeding tendency. CONCLUSION While coagulopathy is rarely observed in patients diagnosed with multiple myeloma, considering an acquired factor X deficiency becomes relevant when such patient present with bleeding diathesis.
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Affiliation(s)
- Amber Coussee
- Department of Laboratory Medicine, AZ Damiaan, Oostende, Belgium
| | - Gudrun Alliet
- Department of Laboratory Medicine, AZ Damiaan, Oostende, Belgium
| | | | | | - Jan Emmerechts
- Department of Laboratory Medicine, AZ Sint-Jan, Brugge, Belgium
| | - Sam Van Hecke
- Department of Haematology, AZ Damiaan, Oostende, Belgium
| | - Lies Persijn
- Department of Laboratory Medicine, AZ Damiaan, Oostende, Belgium
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Livanou ME, Matsas A, Valsami S, Papadimitriou DT, Kontogiannis A, Christopoulos P. Clotting Factor Deficiencies as an Underlying Cause of Abnormal Uterine Bleeding in Women of Reproductive Age: A Literature Review. Life (Basel) 2023; 13:1321. [PMID: 37374104 DOI: 10.3390/life13061321] [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: 04/25/2023] [Revised: 05/27/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Clotting Factor deficiencies are rare disorders with variations in clinical presentation and severity of symptoms ranging from asymptomatic to mild to life-threatening bleeding. Thus, they pose a diagnostic and therapeutic challenge, mainly for the primary health care providers, general practitioners, and gynecologists who are more likely to first encounter these patients. An additional diagnostic challenge arises from the variable laboratory presentations, as PT, PTT, and BT are not always affected. The morbidity is higher among women of reproductive age since Abnormal Uterine Bleeding-specifically Heavy Menstrual Bleeding-is one of the most prevalent manifestations of these disorders, and in some cases of severe deficiencies has led to life-threatening episodes of bleeding requiring blood transfusions or even immediate surgical intervention. Physician awareness is important as, in the case of some of these disorders-i.e., Factor XIII deficiency-prophylactic treatment is available and recommended. Although uncommon, the potential for rare bleeding disorders and for hemophilia carrier states should be considered in women with HMB, after more prevalent causes have been excluded. Currently, there is no consensus on the management of women in these instances and it is reliant on the physicians' knowledge.
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Affiliation(s)
- Maria Effrosyni Livanou
- Second Department of Obstetrics and Gynecology, "Aretaieion" Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Alkis Matsas
- Second Department of Obstetrics and Gynecology, "Aretaieion" Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Serena Valsami
- Hematology Laboratory-Blood Bank, Aretaieion Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Dimitrios T Papadimitriou
- Second Department of Obstetrics and Gynecology, "Aretaieion" Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Athanasios Kontogiannis
- Second Department of Obstetrics and Gynecology, "Aretaieion" Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Panagiotis Christopoulos
- Second Department of Obstetrics and Gynecology, "Aretaieion" Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
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6
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Souri M, Osaki T, Shimura Y, Ichikawa S, Mori M, Ogawa Y, Ichinose A. Identification of non-neutralizing anti-factor X autoantibodies in three Japanese cases of autoimmune acquired factor X deficiency. Haemophilia 2023; 29:555-563. [PMID: 36478471 DOI: 10.1111/hae.14711] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Autoimmune factor X (FX or F10) deficiency (AiF10D) is an extremely rare acquired haemorrhagic disorder characterized by a severe reduction in FX activity due to autoantibodies against FX. AIM Anti-FX autoantibodies were investigated in four patients with suspected AiF10D, and their properties were analysed. METHODS AND RESULTS Anti-FX auto antibodies in plasma were detected by ELISA with three of four cases. One case of anti-FX autoantibody negativity was later diagnosed as AL-amyloidosis. IgG1 and IgG3 coexisted in all anti-FX autoantibodies of the three patients with AiF10D (cases X1, X2, and X3). Western blot analysis showed that the antibodies were bound to the FX light chain for cases X2 and X3, but the binding was weak for case X1. When the fusion proteins of a secretory luciferase with full-length FX or its γ-carboxylated glutamic acid (Gla) domain were added to the plasma of the three patients, both fusion proteins were immunoprecipitated as antigen-antibody complexes. Contrarily, the latter fusion protein produced in the presence of warfarin demonstrated a decrease in the collection rate, suggesting that their autoantibodies recognized the light chain and regions containing Gla residues. Since all three patients were essentially negative for FX inhibitors, it was concluded that the anti-FX autoantibodies for these cases were predominantly non-neutralizing. The concentration of the FX antigen also significantly reduced in these patients, suggesting that anti-FX autoantibodies promote the clearance of FX. CONCLUSION Immunological anti-FX autoantibody detection is highly recommended to ensure that AiF10D cases are not overlooked, and to start necessary immunosuppressive therapies.
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Affiliation(s)
- Masayoshi Souri
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata, Japan.,Japanese Collaborative Research Group on Autoimmune Coagulation Factor Deficiency supported by the Japanese Ministry of Health, Labor and Welfare, Yamagata, Japan.,Department of Public Health and Hygiene, Yamagata University School of Medicine, Yamagata, Japan
| | - Tsukasa Osaki
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata, Japan.,Japanese Collaborative Research Group on Autoimmune Coagulation Factor Deficiency supported by the Japanese Ministry of Health, Labor and Welfare, Yamagata, Japan.,Department of Public Health and Hygiene, Yamagata University School of Medicine, Yamagata, Japan
| | - Yuji Shimura
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
| | | | - Makiko Mori
- Department of Clinical Laboratory, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Yoshiyuki Ogawa
- Japanese Collaborative Research Group on Autoimmune Coagulation Factor Deficiency supported by the Japanese Ministry of Health, Labor and Welfare, Yamagata, Japan.,Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akitada Ichinose
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata, Japan.,Japanese Collaborative Research Group on Autoimmune Coagulation Factor Deficiency supported by the Japanese Ministry of Health, Labor and Welfare, Yamagata, Japan
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7
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Singh PK, Chen Z, Horn K, Norris EH. Blocking domain 6 of high molecular weight kininogen to understand intrinsic clotting mechanisms. Res Pract Thromb Haemost 2022; 6:e12815. [PMID: 36254255 PMCID: PMC9561425 DOI: 10.1002/rth2.12815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/05/2022] [Indexed: 11/05/2022] Open
Abstract
Background The contact system is initiated by factor (F) XII activation and the assembly of high molecular weight kininogen (HK) with either FXI or prekallikrein (PK) on a negatively charged surface. Overactivation of this system contributes to thrombosis and inflammation in numerous diseases. To develop effective therapeutics for contact system disorders, a detailed understanding of this pathway is needed. Methods We performed coagulation assays in normal human plasma and various factor-deficient plasmas. To evaluate how HK-mediated PK and FXI activation contributes to coagulation, we used an anti-HK antibody to block access to domain 6 of HK, the region required for efficient activation of PK and FXI. Results FXI's binding to HK and its subsequent activation by activated FXII contributes to coagulation. We found that the 3E8 anti-HK antibody can inhibit the binding of FXI or PK to HK, delaying clot formation in human plasma. Our data show that in the absence of FXI, however, PK can substitute for FXI in this process. Addition of activated FXI (FXIa) or activated PK (PKa) abolished the inhibitory effect of 3E8. Moreover, the requirement of HK in intrinsic coagulation can be largely bypassed by adding FXIa. Like FXIa, exogenous PKa shortened the clotting time in HK-deficient plasma, which was not due to feedback activation of FXII. Conclusions This study improves our understanding of HK-mediated coagulation and provides an explanation for the absence of bleeding in HK-deficient individuals. 3E8 specifically prevented HK-mediated FXI activation; therefore, it could be used to prevent contact activation-mediated thrombosis without altering hemostasis.
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Affiliation(s)
- Pradeep K. Singh
- Patricia and John Rosenwald Laboratory of Neurobiology and GeneticsThe Rockefeller UniversityNew YorkNew YorkUSA
| | - Zu‐Lin Chen
- Patricia and John Rosenwald Laboratory of Neurobiology and GeneticsThe Rockefeller UniversityNew YorkNew YorkUSA
| | - Katharina Horn
- Patricia and John Rosenwald Laboratory of Neurobiology and GeneticsThe Rockefeller UniversityNew YorkNew YorkUSA
| | - Erin H. Norris
- Patricia and John Rosenwald Laboratory of Neurobiology and GeneticsThe Rockefeller UniversityNew YorkNew YorkUSA
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8
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Fallah A, Shams M, Agi E, Jazebi M, Baghaipoor MR, Naderi T, Rezvany MR. Genotypes and phenotypes characterization of 17 Iranian patients with inherited factor X deficiency: identification of a novel mutation: Leu487Phe. Blood Coagul Fibrinolysis 2022; 33:75-82. [PMID: 35140190 DOI: 10.1097/mbc.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Factor X deficiency is a rare bleeding disorder that affects almost 1 : 1000 000 people worldwide. It derives from multiple mutational changes in the factor X gene (F10). The main objective of the present study was to determine a consistent correlation between the clinical presentations and causative genotype. The phenotype and genotype of 17 Iranian patients with reduced factor X activity (FX:C) from 14 unrelated families were analyzed to screen factor X gene expression for any possible mutations and function alteration. Analysis of the sequencing results led to the identification of eight different mutations besides a single nucleotide variation. One of the mutations was novel (Leu487Phe) as studied by means of online analysis programs and molecular modeling. Eight patients were homozygote; three were heterozygote, while six out of 17 patients were symptomatic cases without any mutations. The Arg40Thr missense mutation was detected in three patients including two siblings and was associated with severe bleeding symptoms. Also, two patients were identified with Gly262Asp missense mutation which commonly presented with bleeding disorder. Each of the other patients was associated with a unique missense mutation including one novel mutation in which the tentative relation of the mutation to bleeding symptoms is reported. Mutations leading to a FX:C of less than 1% are associated with severe bleeding symptoms confirming the strong correlation between clinical severity and FX:C. The novel Leu487Phe mutation with FX:C of 13% may have possible negative effects on factor X protein function resulting in minor clinical manifestation.
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Affiliation(s)
- Aysan Fallah
- Department of Hematology, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran
| | - Mahmood Shams
- Department of Laboratory Sciences, Paramedical Faculty, Babol University of Medical Sciences, Babol
| | - Elnaz Agi
- Iranian Comprehensive Hemophilia Care Center, Blood and Viral Disease Research Center
| | - Mohammad Jazebi
- Iranian Comprehensive Hemophilia Care Center, Blood and Viral Disease Research Center
| | - Mohammad R Baghaipoor
- Iranian Comprehensive Hemophilia Care Center, Blood and Viral Disease Research Center
| | - Tohid Naderi
- Department of Laboratory Sciences, Paramedical Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad R Rezvany
- Department of Hematology, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran
- Department of Oncology-Pathology, Immune and Gene Therapy Lab, Cancer Center Karolinska (CCK), Karolinska University Hospital Solna and Karolinska Institute, Stockholm, Sweden
- Pediatrics Growth and Development Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
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9
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[Congenital factor X deficiency: a retrospective analysis of 11 cases]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:26-30. [PMID: 35231989 PMCID: PMC8980670 DOI: 10.3760/cma.j.issn.0253-2727.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To analyze the clinical characteristics, laboratory examination, diagnosis, treatment, and outcome of hereditary factor Ⅹ (FⅩ) deficiency. Methods: Clinical data of 11 patients with congenital FⅩ deficiency were retrospectively analyzed from July 2009 to February 2021. Results: There were 3 males and 8 females. Median age was 39 (5-55) years. The media duration of follow-up was 81.67 (1.87-142.73) months. Of the 11 patients, 10 had bleeding symptoms, 7 had ecchymosis or hemorrhage after skin bump, 7 had nosebleed, 6 had gingival hemorrhage, and 1 had muscle hematoma. Among the female patients, 6 had menorrhagia and 1 experienced bleeding after vaginal delivery. Family history of FⅩ deficiency was found in one case. Eight patients had a history of surgery, and four had postoperative bleeding. Laboratory findings were characterized by significantly prolonged activated partial thromboplastin time, prothrombin time, and decreased FⅩ activity (FⅩ∶C) . Four cases underwent gene mutation analysis and five new mutations were found. Four cases were treated with prothrombin complex concentrates (PCC) and seven cases with fresh frozen plasma (FFP) . One female patient had significantly reduced menstrual volume after PCC prophylactic therapy. One patient received FFP for prophylactic infusion with no bleeding during and after the operation. Conclusion: Most patients with congenital FⅩ deficiency had bleeding symptoms and there was no significant correlation between severity of bleeding symptoms and FⅩ∶C. Prophylaxis should be applied in patients with severe bleeding tendencies. Gene mutation test is significant for screening, diagnosis, and prognosis prediction of congenital FX deficiency.
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10
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A Rare Cause of Acquired Factor X Deficiency in an 87-Year-Old Female. Case Rep Hematol 2021; 2021:1138329. [PMID: 34840836 PMCID: PMC8612776 DOI: 10.1155/2021/1138329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/07/2021] [Accepted: 11/09/2021] [Indexed: 11/18/2022] Open
Abstract
Factor X deficiency is a rare coagulopathy that can be inherited or acquired. Acquired factor X deficiency has been associated with plasma cell dyscrasias, amyloids, and use of vitamin K antagonists. Of plasma cell dyscrasias, most cases in the literature have been associated with multiple myeloma with or without concomitant AL amyloidosis. Here, we present a rare case of acquired isolated factor X deficiency in an elderly patient with immunoglobulin A (Ig A) monoclonal gammopathy of undetermined significance (MGUS). Herein, we highlight a rare cause of acquired factor X deficiency, and we hope to contribute to the growing literature of plasma cell dyscrasias associated with factor X deficiency.
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11
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Harris VA, Lin W, Perkins SJ. Analysis of 180 Genetic Variants in a New Interactive FX Variant Database Reveals Novel Insights into FX Deficiency. TH OPEN 2021; 5:e557-e569. [PMID: 35059555 PMCID: PMC8763577 DOI: 10.1055/a-1704-0841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/15/2021] [Indexed: 12/03/2022] Open
Abstract
Coagulation factor X (FX), often termed as Stuart–Prower factor, is a plasma glycoprotein composed of the γ-carboxyglutamic acid (GLA) domain, two epidermal growth factor domains (EGF-1 and EGF-2), and the serine protease (SP) domain. FX plays a pivotal role in the coagulation cascade, activating thrombin to promote platelet plug formation and prevent excess blood loss. Genetic variants in FX disrupt coagulation and lead to FX or Stuart–Prower factor deficiency. To better understand the relationship between FX deficiency and disease severity, an interactive FX variant database has been set up at
https://www.factorx-db.org
, based on earlier web sites for the factor-XI and -IX coagulation proteins. To date (April 2021), we report 427 case reports on FX deficiency corresponding to 180 distinct
F10
genetic variants. Of
these, 149 are point variants (of which 128 are missense), 22 are deletions, 3 are insertions, and 6 are polymorphisms. FX variants are phenotypically classified as being type I or II. Type-I variants involve the simultaneous reduction of FX coagulant activity (FX:C) and FX antigen levels (FX:Ag), whereas type-II variants involve a reduction in FX:C with normal FX:Ag plasma levels. Both types of variants were distributed throughout the FXa protein structure. Analyses based on residue surface accessibilities showed the most damaging variants to occur at residues with low accessibilities. The interactive FX web database provides a novel easy-to-use resource for clinicians and scientists to improve the understanding of FX deficiency. Guidelines are provided for clinicians who wish to use the database for diagnostic purposes.
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Affiliation(s)
- Victoria A. Harris
- Research Department of Structural and Molecular Biology, University College London, Darwin Building, Gower Street, London, United Kingdom
| | - Weining Lin
- Research Department of Structural and Molecular Biology, University College London, Darwin Building, Gower Street, London, United Kingdom
| | - Stephen J. Perkins
- Research Department of Structural and Molecular Biology, University College London, Darwin Building, Gower Street, London, United Kingdom
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12
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Gurlek Gokcebay D, Kacar D, Sahin S, Girolami A, Yarali N, Ozbek NY. A Rare Cause of Isolated Prothrombin Time Prolongation: Congenital Factor X Deficiency. J Pediatr Hematol Oncol 2021; 43:e1248-e1250. [PMID: 33902062 DOI: 10.1097/mph.0000000000002180] [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] [Indexed: 11/25/2022]
Affiliation(s)
- Dilek Gurlek Gokcebay
- Department of Pediatric Hematology, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - Dilek Kacar
- Department of Pediatric Hematology, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - Seda Sahin
- Department of Pediatric Hematology, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - Antonio Girolami
- Department of Medicine, University of Padua Medical School, Padua, Italy
| | - Nese Yarali
- Department of Pediatric Hematology, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - Namik Y Ozbek
- Department of Pediatric Hematology, University of Health Sciences Ankara City Hospital, Ankara, Turkey
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13
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Ichinose A, Osaki T, Souri M. Autoimmune Coagulation Factor X Deficiency as a Rare Acquired Hemorrhagic Disorder: A Literature Review. Thromb Haemost 2021; 122:320-328. [PMID: 33930902 DOI: 10.1055/a-1496-8527] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Coagulation factor X (F10) amplifies the clotting reaction in the middle of the coagulation cascade, and thus F10 deficiency leads to a bleeding tendency. Isolated acquired F10 deficiency is widely recognized in patients with immunoglobulin light-chain amyloidosis or plasma cell dyscrasias. However, its occurrence as an autoimmune disorder is extremely rare. The Japanese Collaborative Research Group has been conducting a nationwide survey on autoimmune coagulation factor deficiencies (AiCFDs) starting in the last decade; we recently identified three patients with autoimmune F10 deficiency (AiF10D). Furthermore, an extensive literature search was performed, confirming 26 AiF10D and 28 possible cases. Our study revealed that AiF10D patients were younger than patients with other AiCFDs; AiF10D patients included children and were predominantly male. AiF10D was confirmed as a severe type of bleeding diathesis, although its mortality rate was not high. As AiF10D patients showed only low F10 inhibitor titers, they were considered to have nonneutralizing anti-F10 autoantibodies rather than their neutralizing counterparts. Accordingly, immunological anti-F10 antibody detection is highly recommended. Hemostatic and immunosuppressive therapies may help arrest bleeding and eliminate anti-F10 antibodies, leading to a high recovery rate. However, further investigation is necessary to understand the basic characteristics and proper management of AiF10D owing to the limited number of patients.
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Affiliation(s)
- Akitada Ichinose
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata, Japan.,The Japanese Collaborative Research Group (JCRG) on Autoimmune Acquired Coagulation Factor Deficiencies supported by the Japanese Ministry of Health, Labor and Welfare (MHLW), Japan
| | - Tsukasa Osaki
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata, Japan.,The Japanese Collaborative Research Group (JCRG) on Autoimmune Acquired Coagulation Factor Deficiencies supported by the Japanese Ministry of Health, Labor and Welfare (MHLW), Japan.,Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science, Iida-Nishi, Yamagata, Japan
| | - Masayoshi Souri
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata, Japan.,The Japanese Collaborative Research Group (JCRG) on Autoimmune Acquired Coagulation Factor Deficiencies supported by the Japanese Ministry of Health, Labor and Welfare (MHLW), Japan.,Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science, Iida-Nishi, Yamagata, Japan
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14
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Camire RM. Blood coagulation factor X: molecular biology, inherited disease, and engineered therapeutics. J Thromb Thrombolysis 2021; 52:383-390. [PMID: 33886037 DOI: 10.1007/s11239-021-02456-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 12/19/2022]
Abstract
Blood coagulation factor X/Xa sits at a pivotal point in the coagulation cascade and has a role in each of the three major pathways (intrinsic, extrinsic and the common pathway). Due to this central position, it is an attractive therapeutic target to either enhance or dampen thrombin generation. In this brief review, I will summarize key developments in the molecular understanding of this critical clotting factor and discuss the molecular basis of FX deficiency, highlight difficulties in expressing recombinant factor X, and detail two factor X variants evaluated clinically.
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Affiliation(s)
- Rodney M Camire
- Division of Hematology and the Raymond G. Perelman Center for Cellular and Molecular Therapeutics, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA. .,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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15
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Dargan C, Kaufman CB, Oroszi G, Miller CPK, Carter-Reardon L, Blue E, Wicklund BM. Management of a hemispherotomy for Rasmussen encephalitis in a patient with mild factor 10 deficiency and low von Willebrand factor levels. Haemophilia 2021; 27:e513-e516. [PMID: 33548145 DOI: 10.1111/hae.14249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Chandni Dargan
- Hematology/Oncology Division, Department of Pediatrics, Children's Mercy- Kansas City, Kansas City, Missouri, USA
| | - Christian B Kaufman
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Gabor Oroszi
- Department of Pathology and Laboratory Medicine, Children's Mercy- Kansas City, Kansas City, Missouri, USA
| | - Christopher P K Miller
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Lucy Carter-Reardon
- Hematology/Oncology Division, Department of Pediatrics, Children's Mercy- Kansas City, Kansas City, Missouri, USA
| | - Eric Blue
- Department of Pathology and Laboratory Medicine, Children's Mercy- Kansas City, Kansas City, Missouri, USA
| | - Brian M Wicklund
- Hematology/Oncology Division, Department of Pediatrics, Children's Mercy- Kansas City, Kansas City, Missouri, USA
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16
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Thau A, Saffren B, Zakrzewski H, Anderst JD, Carpenter SL, Levin A. Retinal hemorrhage and bleeding disorders in children: A review. CHILD ABUSE & NEGLECT 2021; 112:104901. [PMID: 33401159 DOI: 10.1016/j.chiabu.2020.104901] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/27/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Retinal hemorrhages (RH) are a common manifestation of abusive head trauma (AHT) resulting from acceleration-deceleration injury with or without blunt impact. Evaluation of a child with RH requires careful consideration of these differential diagnoses. The extent to which coagulopathy alone can cause RH would be useful to understand as coagulopathy may accompany AHT. OBJECTIVE In this systematic review, we sought to identify whether coagulopathies have been reported with RH similar to those of AHT. METHODS We performed a literature search for ocular manifestations of bleeding disorders in children less than 18 years old. We included clotting factor deficiencies, vitamin K deficiency, platelet function abnormalities, thrombocytopenia, disseminated intravascular coagulation (DIC), and trauma induced coagulopathy (TIC). We included only pediatric reports of intraocular bleeding or documented eye examinations that indicated no hemorrhages. We then re-examined cases for ocular and systemic findings that could potentially mimic abuse. RESULTS Our initial search yielded 816 results. Sixty-one articles met our inclusion criteria. Of these, there were 32 children within the AHT age range (less than 5 years old) who had RH and concomitant coagulopathy. Only 5 cases might potentially be confused for abuse. Of these, no classic characteristics of RH from abuse such as retinoschisis or retinal folds were found. Systemic features were inconsistent with AHT. CONCLUSIONS The presence of coagulopathy alone does not rule out the possibility that the child has been abused. Coagulopathy alone has not been reported as an etiology of RH that are consistent with AHT, especially when other findings are present.
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Affiliation(s)
- Avrey Thau
- Thomas Jefferson University, Philadelphia, PA, USA
| | - Brooke Saffren
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Helena Zakrzewski
- Department of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - James D Anderst
- Division of Child Adversity and Resilience, Children's Mercy Hospital, Kansas City, MO, USA
| | - Shannon L Carpenter
- Department of Hematology, Oncology, and Bone Marrow Transplantation, Children's Mercy Hospital, Kansas City, MO, USA
| | - Alex Levin
- Flaum Eye Institute and Golisano Children's Hospital, University of Rochester, New York, USA.
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17
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Gkalea V, Amiot X, Jo Molina T, Frenzel L, Bachmeyer C. Intraperitoneal bleeding as the initial presentation of Randall-type monoclonal immunoglobulin deposition disease with hepatic involvement. Leuk Lymphoma 2020; 62:1263-1266. [PMID: 33300421 DOI: 10.1080/10428194.2020.1856836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Xavier Amiot
- Department of Hepatology, Tenon Hospital, Paris, France
| | - Thierry Jo Molina
- Departement of Pathology, Necker-Enfants Malades Hospitals, Paris, France
| | - Laurent Frenzel
- Department of Hematology, Necker-Enfants Malades Hospital, Paris, France
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18
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Baker P, Platton S, Gibson C, Gray E, Jennings I, Murphy P, Laffan M. Guidelines on the laboratory aspects of assays used in haemostasis and thrombosis. Br J Haematol 2020; 191:347-362. [PMID: 32537743 DOI: 10.1111/bjh.16776] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Peter Baker
- Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sean Platton
- Haemophilia Centre, Barts Health NHS Trust, London, UK
| | - Claire Gibson
- Specialist Haemostasis, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Elaine Gray
- Haemostasis Section, Biotherapeutics Group, National Institute for Biological Standards and Controls, Hertfordshire, UK
| | | | - Paul Murphy
- Department of Haematology, the Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mike Laffan
- Centre for Haematology, Imperial College and Hammersmith Hospital, London, UK
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19
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Abstract
Early diagnosis of AL amyloidosis and appreciation of the nutritional and coagulation abnormalities associated with liver and gastrointestinal involvement are critically important in the treatment and management. In cases of severe malabsorption total parenteral nutrition can be extremely helpful as a bridge to organ improvement. Rarely the use of antifibrinolytic agents such as oral aminocaproic acid with transfusion support may control severe bleeding in patients with coagulation abnormalities. It is important to keep in mind that organ improvement should follow in lag phase after the reduction in the pathologic free light chain with treatment. Closely following light chain levels may permit brief holidays from treatment and enable periods of recovery before resuming therapy in patients with prompt early and deep hematologic responses.
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Affiliation(s)
- Michael Rosenzweig
- City of Hope Helford Clinical Research Hospital, City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Raymond L Comenzo
- John C Davis Myeloma and Amyloid Program, Tufts University School of Medicine, Tufts Medical Center, Box 826, 800 Washington Street, Boston, MA 02111, USA.
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20
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Girolami A, Ferrari S, Girolami B, Molaro G. The slow but progressive disappearance of the patients with the Pro343Ser (FX Friuli) mutation. Br J Haematol 2020; 191:e50-e52. [DOI: 10.1111/bjh.16991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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
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21
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Lu S, Lin W, Ji H, Su M, Zhao X, Wang C. A Compound Heterozygosis of Two Novel Mutations Causes Factor X Deficiency in a Chinese Pedigree. Acta Haematol 2020; 144:176-181. [PMID: 32599596 DOI: 10.1159/000507689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/03/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mutations in the F10-coding gene can cause factor X (FX) deficiency, leading to abnormal coagulation activity and severe tendency for hemorrhage. Therefore, identifying mutations in F10 is important for diagnosing congenital FX deficiency. METHODS We studied a 63-year-old male patient with FX deficiency and 10 of his family members. Clotting and immunological methods were used to determine activated partial thromboplastin time (aPTT), prothrombin time (PT), thrombin time (TT), fibrinogen levels, FX activity, and FX antigen levels. The platelet count was determined. A mixing study was performed to eliminate the presence of coagulation factor inhibitors and lupus anticoagulant. Mutations were searched using whole-exome sequencing and certified by Sanger sequencing. RESULTS Genetic analysis of the proband identified two single-base substitutions: c.1085G>A (p.Ser362Asn) and c.1152C>A (p.Tyr384Ter, termination codon, caused by the DNA sequence TAA). His FX activity and antigen levels were 1.7% and 408.53 pg/mL, respectively; aPTT and PT were 52.3 and 48.0 s, respectively. One brother had the same compound heterozygous mutations, and his FX activity and antigen levels were 1.3% and 465.47 pg/mL, respectively; his aPTT and PT were 65.2 and 54.5 s, respectively. His mother, another brother, and one sister were heterozygous for c.1085G>A (p.Ser362Asn), and his daughter and grandson (6 years old) were heterozygous for c.1152C>A (p.Tyr384Ter). CONCLUSION The heterozygous variants p.Ser362Asn or p.Tyr384Ter indicate mild FX deficiency, but the compound heterozygous mutation of the two causes severe congenital FX deficiency and bleeding. Genetic analysis of these two mutations may help characterize the bleeding tendency and confirm congenital FX deficiency.
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Affiliation(s)
- Songsong Lu
- Medical Laboratory Center, First Medical Center of Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Weicheng Lin
- Department of Orthopedic Trauma, Peking University People's Hospital, Beijing, China
| | - Huijuan Ji
- Intensive Care Unit, Peking University People's Hospital, Beijing, China
| | - Ming Su
- Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Xiaotao Zhao
- Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Chengbin Wang
- Medical Laboratory Center, First Medical Center of Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China,
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22
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Ichikawa S, Saito K, Fukuhara N, Tanaka Y, Lee Y, Onodera K, Onishi Y, Yokoyama H, Fujiwara M, Harigae H. Successful Treatment of Life-threatening Bleeding Caused by Acquired Factor X Deficiency Associated with Respiratory Infection. Intern Med 2020; 59:1303-1308. [PMID: 32023586 PMCID: PMC7303456 DOI: 10.2169/internalmedicine.4142-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Acquired factor X deficiency (AFXD) is a very rare coagulation disorder. A 40-year-old man with no comorbidities suffering from a fever, malaise, and severe hemorrhagic symptoms, including massive hematuria, was emergently admitted. His platelet count was normal, but his prothrombin time and activated partial thromboplastin time were markedly prolonged, which was thought to be due to autoantibody against a coagulation factor in the common pathway. Despite severe massive hematuria resulting in transient renal failure, he was successfully treated with urgent immunosuppressive therapy. Computed tomography revealed bronchopneumonia, which improved with antibiotic administration. AFXD without evidence of amyloidosis was subsequently diagnosed.
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Affiliation(s)
- Satoshi Ichikawa
- Department of Hematology and Rheumatology, Tohoku University Hospital, Japan
| | - Kei Saito
- Department of Hematology and Rheumatology, Tohoku University Hospital, Japan
| | - Noriko Fukuhara
- Department of Hematology and Rheumatology, Tohoku University Hospital, Japan
| | - Yuya Tanaka
- Department of Hematology and Rheumatology, Tohoku University Hospital, Japan
| | - Yoonha Lee
- Department of Hematology and Rheumatology, Tohoku University Hospital, Japan
| | - Koichi Onodera
- Department of Hematology and Rheumatology, Tohoku University Hospital, Japan
| | - Yasushi Onishi
- Department of Hematology and Rheumatology, Tohoku University Hospital, Japan
| | - Hisayuki Yokoyama
- Department of Hematology and Rheumatology, Tohoku University Hospital, Japan
| | - Minami Fujiwara
- Department of Hematology and Rheumatology, Tohoku University Hospital, Japan
| | - Hideo Harigae
- Department of Hematology and Rheumatology, Tohoku University Hospital, Japan
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23
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Molecular mechanism of a novel Ser362Asn mutation causing inherited FX deficiency in a Chinese family. Int J Hematol 2020; 112:8-16. [PMID: 32285359 DOI: 10.1007/s12185-020-02877-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
Abstract
Factor X (FX) deficiency is an inherited autosomal recessive bleeding disorder. Here, we analyzed a proband with FX deficiency in a Chinese family. Genetic analysis revealed that the proband and his affected sister was homozygous for c.1085G>A mutation, corresponding to a Ser362Asn substitution. In vitro expression experiments showed that the FX Ser362Asn mutation led to a significant reduction in activity levels in the culture medium. This Ser to Asn substitution may change the shape of the active site. Moreover, simulations of molecular dynamics indicated that the binding energy of the FX Ser362Asn to the substrate is higher than that of wild type and the side-chain conformation of the catalytic residue His276 (His42) is changed. This impairs the conformational switch of the protein from zymogen to proteinase, thus causing the functional defect of FX protein. Our findings suggest that the Ser362Asn substitution is a pathogenic mutation that causes inherited FX deficiency.
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24
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Villarreal-Martínez L, Ibarra-Ramirez M, Calvo-Anguiano G, Lugo-Trampe JDJ, Luna-Záizar H, Martínez-de-Villarreal LE, Meléndez-Aranda L, Jaloma-Cruz AR. Molecular genetic diagnosis by next-generation sequencing in a cohort of Mexican patients with haemophilia and report of novel variants. Blood Cells Mol Dis 2020; 83:102423. [PMID: 32224444 DOI: 10.1016/j.bcmd.2020.102423] [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] [Received: 02/20/2020] [Accepted: 03/08/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Molecular analysis in haemophilia is currently used in the diagnosis, treatment and prognosis of this disease. Hispanic populations in Latin America have been of interest to researchers due to the reportedly high prevalence of inhibitors in these patients. AIM To perform next-generation sequencing (NGS) in a cohort of Mexican patients with HA and HB and correlate with clinical phenotypes. METHODS Patients with Haemophilia A (HA) or haemophilia B (HB), were evaluated using NGS with an Ion AmpliSeq Custom Panel. Odds ratios (ORs) for associations between F8 variants and inhibitors were obtained. RESULTS A total of 85 patients (60 with HA and 25 with HB) were included. Pathogenic variants in F8 were found in 93.3% of HA patients and in F9 in 96% of HB patients. Twelve novel potentially pathogenic variants were found. Inhibitors were observed in 20% of patients with severe HA. Four patients clinically diagnosed with HA were negative for F8 variants. CONCLUSION Overall detection rate of pathogenic variants in F8 and F9 genes was 94.6%. We identified 12 non previously reported variants and pathogenic variants in other coagulation related genes. Molecular diagnosis of HA and HB permits better options for management, assessment and genetic counseling.
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Affiliation(s)
- Laura Villarreal-Martínez
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León. Monterrey, Nuevo León, Mexico
| | - Marisol Ibarra-Ramirez
- Department of Genetics, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León. Monterrey, Nuevo León, Mexico
| | - Geovana Calvo-Anguiano
- Department of Genetics, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León. Monterrey, Nuevo León, Mexico
| | - José de Jesús Lugo-Trampe
- Department of Genetics, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León. Monterrey, Nuevo León, Mexico
| | - Hilda Luna-Záizar
- Departamento de Química, Centro Universitario de Ciencias Exactas e Ingenierías, Universidad de Guadalajara. Guadalajara, Jalisco, Mexico
| | - Laura Elia Martínez-de-Villarreal
- Department of Genetics, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León. Monterrey, Nuevo León, Mexico
| | - Lennon Meléndez-Aranda
- División de Genética, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico; Doctorado en Genética Humana, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara Guadalajara, Jalisco, Mexico
| | - Ana-Rebeca Jaloma-Cruz
- División de Genética, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico.
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25
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Krkovic M, Koosova Gajic A, Tarčuković J, Sotosek V, Stimac T, Balen S, Dangubic B, Grubjesic I. Factor X Deficiency Management for Elective Cesarean Delivery in a Pregnant Patient. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e920685. [PMID: 32184380 PMCID: PMC7117852 DOI: 10.12659/ajcr.920685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 39-year-old Final Diagnosis: Factor X deficiency Symptoms: Menstrual bleeding Medication: Solvent-detergent-treated fresh frozen plasma Clinical Procedure: Elective cesarean section Specialty: Obstetrics and Gynecology
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Affiliation(s)
- Mirna Krkovic
- Department of Anesthesiology, Intensive Care and Pain Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Andrea Koosova Gajic
- Department of Anesthesiology, Intensive Care and Pain Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Janja Tarčuković
- Department of Anesthesiology, Intensive Care and Pain Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia.,Department of Anesthesiology, Resuscitation, Emergency and Intensive Care Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Vlatka Sotosek
- Department of Anesthesiology, Intensive Care and Pain Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia.,Department of Anesthesiology, Resuscitation, Emergency and Intensive Care Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Tea Stimac
- Department of Gynaecology and Obstetrics, Clinical Hospital Center Rijeka, Rijeka, Croatia.,Department of Gynecology and Obstetrics, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Sanja Balen
- Clinical Institute for Transfusion Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia.,Department of Clinical Laboratory Diagnostics, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Boban Dangubic
- Department of Anesthesiology, Intensive Care and Pain Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Igor Grubjesic
- Department of Anesthesiology, Intensive Care and Pain Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia
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26
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Abstract
: Rare bleeding disorders usually begin in childhood and manifest as varying degrees of bleeding, which can be life-threatening in severe cases. With the development of gene editing technology, it is expected that hereditary coagulation factor disorders will someday be fundamentally cured by gene therapy. On account of their rarity, comprehension of these diseases is essential for the application of new treatment strategies. We have compiled the features of some newly discovered mutations of prothrombin, factor VII, and factor X in recent years. In addition, this review introduces the advances and obstacles in gene therapy.
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27
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Inherited Moderate Factor X Deficiency Presenting as Cardiac Tamponade. Case Rep Hematol 2019; 2019:9657516. [PMID: 31662920 PMCID: PMC6778902 DOI: 10.1155/2019/9657516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/29/2019] [Accepted: 09/11/2019] [Indexed: 11/20/2022] Open
Abstract
Factor X deficiency is a rare bleeding disorder that varies in the severity of its clinical manifestations. The symptoms of this disorder can occur at any age, although most severe cases appear in childhood. The rarity of this condition has not allowed for the establishment of evidence‐based management guidelines, and thus, individuals afflicted with factor X deficiency are treated based on limited literature and the opinions of clinicians with extensive experience. In this case report, we discuss a unique presentation of a 38-year-old male who was found to have cardiac tamponade as a result of his newly diagnosed inherited moderate factor X deficiency. This was discovered by obtaining a factor X activity assay and confirmed with genetic testing which demonstrated a missense variant on the factor X gene on chromosome 13. His management involved correction of his factor X deficiency with fresh frozen plasma, a pericardiocentesis, and placement of a pericardial window. He has been asymptomatic and without hemorrhagic episodes for the 10 months following his discharge.
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28
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Reynolds SB, Maghavani DP, Hashmi H. Acquired factor X deficiency in a patient with multiple myeloma: a rare case highlighting the significance of comprehensive evaluation and the need for antimyeloma therapy for bleeding diathesis. BMJ Case Rep 2019; 12:e230249. [PMID: 31527206 PMCID: PMC6754647 DOI: 10.1136/bcr-2019-230249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2019] [Indexed: 11/04/2022] Open
Abstract
Factor X deficiency is a rare bleeding disorder that can be associated with life-threatening bleeding events. Factor X deficiency can either be inherited or acquired. Acquired cases of factor X deficiency can be seen in patients with plasma cell dyscrasias as well as amyloidosis. Coagulopathy, with clinically relevant bleeding events, although rare, is not an unusual phenomenon for patients with systemic amyloidosis. However, clinically relevant bleeding in patients with symptomatic multiple myeloma, without associated amyloidosis, has not been reported in literature before. We present a rare case of multiple myeloma without concomitant amyloidosis that presented with life-threatening bleeding from acquired deficiency of factor X and responded remarkably to treatment for underlying multiple myeloma. This case not only highlights the diagnostic workup required in patients with factor X deficiency but also provides the principles of management of acquired coagulopathy in plasma cell dyscrasias.
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Affiliation(s)
- Samuel Benjamin Reynolds
- Department of Internal Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | | | - Hamza Hashmi
- Division of Medical Oncology and Hematology, University of Louisville, Louisville, Kentucky, USA
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29
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A Phenome-Wide Association Study Uncovers a Pathological Role of Coagulation Factor X during Acinetobacter baumannii Infection. Infect Immun 2019; 87:IAI.00031-19. [PMID: 30782860 DOI: 10.1128/iai.00031-19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 02/14/2019] [Indexed: 01/30/2023] Open
Abstract
Coagulation and inflammation are interconnected, suggesting that coagulation plays a key role in the inflammatory response to pathogens. A phenome-wide association study (PheWAS) was used to identify clinical phenotypes of patients with a polymorphism in coagulation factor X. Patients with this single nucleotide polymorphism (SNP) were more likely to be hospitalized with hemostatic and infection-related disorders, suggesting that factor X contributes to the immune response to infection. To investigate this, we modeled infections by human pathogens in a mouse model of factor X deficiency. Factor X-deficient mice were protected from systemic Acinetobacter baumannii infection, suggesting that factor X plays a role in the immune response to A. baumannii Factor X deficiency was associated with reduced cytokine and chemokine production and alterations in immune cell population during infection: factor X-deficient mice demonstrated increased abundance of neutrophils, macrophages, and effector T cells. Together, these results suggest that factor X activity is associated with an inefficient immune response and contributes to the pathology of A. baumannii infection.
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Spiliopoulos D, Kadir RA. Congenital Factor X deficiency in women: A systematic review of the literature. Haemophilia 2019; 25:195-204. [DOI: 10.1111/hae.13729] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Dimitrios Spiliopoulos
- Katharine Dormandy Haemophilia Centre, Department of Obstetrics & Gynaecology Royal Free Hospital London UK
| | - Rezan A. Kadir
- Katharine Dormandy Haemophilia Centre, Department of Obstetrics & Gynaecology Royal Free Hospital London UK
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Mori M, Mochizuki K, Souri M, Nakamura Y, Tokuman N, Kanouchi K, Morikane K, Ichinose A. Complete remission in a bleeding patient with idiopathic autoimmune factor X deficiency caused by non-neutralizing anti-factor X autoantibody. Haemophilia 2018; 25:e106-e109. [PMID: 30570186 DOI: 10.1111/hae.13675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/18/2018] [Accepted: 12/04/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Makiko Mori
- Department of Clinical Laboratory, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Kanako Mochizuki
- Department of Hematology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Masayoshi Souri
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata, Japan.,Japanese Collaborative Research Group on Autoimmune Coagulation Factor Deficiencies (JCRG), Yamagata, Japan
| | - Yuka Nakamura
- Department of Clinical Laboratory, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Naoko Tokuman
- Department of Clinical Laboratory, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Kazunori Kanouchi
- Japanese Collaborative Research Group on Autoimmune Coagulation Factor Deficiencies (JCRG), Yamagata, Japan.,Department of Clinical Laboratory Medicine, Yamagata University School of Medicine, Yamagata, Japan
| | - Keita Morikane
- Japanese Collaborative Research Group on Autoimmune Coagulation Factor Deficiencies (JCRG), Yamagata, Japan.,Department of Clinical Laboratory Medicine, Yamagata University School of Medicine, Yamagata, Japan
| | - Akitada Ichinose
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata, Japan.,Japanese Collaborative Research Group on Autoimmune Coagulation Factor Deficiencies (JCRG), Yamagata, Japan
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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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Chan JKY, Gil-Farina I, Johana N, Rosales C, Tan YW, Ceiler J, Mcintosh J, Ogden B, Waddington SN, Schmidt M, Biswas A, Choolani M, Nathwani AC, Mattar CNZ. Therapeutic expression of human clotting factors IX and X following adeno-associated viral vector-mediated intrauterine gene transfer in early-gestation fetal macaques. FASEB J 2018; 33:3954-3967. [PMID: 30517034 PMCID: PMC6404563 DOI: 10.1096/fj.201801391r] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Adeno-associated viral vectors (AAVs) achieve stable therapeutic expression without long-term toxicity in adults with hemophilia. To avert irreversible complications in congenital disorders producing early pathogenesis, safety and efficacy of AAV-intrauterine gene transfer (IUGT) requires assessment. We therefore performed IUGT of AAV5 or -8 with liver-specific promoter-1 encoding either human coagulation factors IX (hFIX) or X (hFX) into Macaca fascicularis fetuses at ∼0.4 gestation. The initial cohort received 1 × 1012 vector genomes (vgs) of AAV5-hFIX (n = 5; 0.45 × 1013 vg/kg birth weight), resulting in ∼3.0% hFIX at birth and 0.6–6.8% over 19–51 mo. The next cohort received 0.2–1 × 1013 vg boluses. AAV5-hFX animals (n = 3; 3.57 × 1013 vg/kg) expressed <1% at birth and 9.4–27.9% up to 42 mo. AAV8-hFIX recipients (n = 3; 2.56 × 1013 vg/kg) established 4.2–41.3% expression perinatally and 9.8–25.3% over 46 mo. Expression with AAV8-hFX (n = 6, 3.12 × 1013 vg/kg) increased from <1% perinatally to 9.8–13.4% >35 mo. Low expressers (<1%, n = 3) were postnatally challenged with 2 × 1011 vg/kg AAV5 resulting in 2.4–13.2% expression and demonstrating acquired tolerance. Linear amplification–mediated-PCR analysis demonstrated random integration of 57–88% of AAV sequences retrieved from hepatocytes with no events occurring in or near oncogenesis-associated genes. Thus, early-IUGT in macaques produces sustained curative expression related significantly to integrated AAV in the absence of clinical toxicity, supporting its therapeutic potential for early-onset monogenic disorders.—Chan, J. K. Y., Gil-Farina I., Johana, N., Rosales, C., Tan, Y. W., Ceiler, J., Mcintosh, J., Ogden, B., Waddington, S. N., Schmidt, M., Biswas, A., Choolani, M., Nathwani, A. C., Mattar, C. N. Z. Therapeutic expression of human clotting factors IX and X following adeno-associated viral vector–mediated intrauterine gene transfer in early-gestation fetal macaques.
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Affiliation(s)
- Jerry K Y Chan
- Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Cancer and Stem Cell Biology Program, Duke-National University of Singapore (NUS) Medical School, Singapore
| | - Irene Gil-Farina
- Department of Translational Oncology, German Cancer Research Center/National Center for Tumor Diseases, Heidelberg, Germany
| | - Nuryanti Johana
- Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Cecilia Rosales
- University College London (UCL) Cancer Institute, University College London, London, United Kingdom
| | - Yi Wan Tan
- Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jessika Ceiler
- Department of Translational Oncology, German Cancer Research Center/National Center for Tumor Diseases, Heidelberg, Germany
| | - Jenny Mcintosh
- Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bryan Ogden
- SingHealth Experimental Medicine Centre, Singapore Health Services Pte, Singapore, Singapore
| | - Simon N Waddington
- Institute for Women's Health, University College London, London, United Kingdom.,Faculty of Health Sciences, Wits/South African Medical Research Council (SAMRC), Antiviral Gene Therapy Research Unit, University of the Witwatersrand, Johannesburg, South Africa; and
| | - Manfred Schmidt
- University College London (UCL) Cancer Institute, University College London, London, United Kingdom.,GeneWerk, Heidelberg, Germany
| | - Arijit Biswas
- Department of Translational Oncology, German Cancer Research Center/National Center for Tumor Diseases, Heidelberg, Germany
| | - Mahesh Choolani
- Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Amit C Nathwani
- University College London (UCL) Cancer Institute, University College London, London, United Kingdom
| | - Citra N Z Mattar
- Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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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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Franchini M, Marano G, Pupella S, Vaglio S, Masiello F, Veropalumbo E, Piccinini V, Pati I, Catalano L, Liumbruno GM. Rare congenital bleeding disorders. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:331. [PMID: 30306070 DOI: 10.21037/atm.2018.08.34] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The rare congenital bleeding disorders are a heterogeneous group of diseases which include deficiencies of fibrinogen, prothrombin and factors V, V + VIII, VII, X, XI and XIII. They are usually transmitted as autosomal recessive disorders, and the prevalence of the severe forms ranges from one case in 500,000 for factor VII up to one in 2,000,000 for factor XIII in the general population. Patients with rare congenital bleeding disorders may have a broad spectrum of clinical symptoms, ranging from mucocutaneous bleeding to life-threatening haemorrhages, such as those occurring in the central nervous system. The treatment of these disorders is based principally on the replacement of the deficient factor using, when available, specific plasma-derived or recombinant products. The aim of this narrative review is to summarise current knowledge about these rare bleeding conditions.
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Affiliation(s)
- Massimo Franchini
- Italian National Blood Centre, National Institute of Health, Rome, Italy.,Department of Haematology and Transfusion Medicine, Carlo Poma Hospital, Mantua, Italy
| | - Giuseppe Marano
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Simonetta Pupella
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Stefania Vaglio
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Francesca Masiello
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Eva Veropalumbo
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Vanessa Piccinini
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Ilaria Pati
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Liviana Catalano
- Italian National Blood Centre, National Institute of Health, Rome, Italy
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36
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Tan JL, Loh KP, Fortuna D, Ghaneie A. Anticoagulation in atrial fibrillation with factor X deficiency-A management dilemma. Clin Case Rep 2018; 6:1781-1785. [PMID: 30214763 PMCID: PMC6132141 DOI: 10.1002/ccr3.1731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/17/2018] [Accepted: 07/02/2018] [Indexed: 12/19/2022] Open
Abstract
Factor X (FX) deficiency is a rare bleeding disorder. There is currently no clear guideline or recommendation for the appropriate selection of anticoagulation and management of patients with FX deficiency who require anticoagulation. We shared our experience in managing such patient, and we further discussed other possible treatment options.
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Affiliation(s)
- Jian Liang Tan
- Department of Internal MedicineCrozer‐Chester Medical CenterUplandPennsylvania
| | - Kah Poh Loh
- Division of Hematology and OncologyStrong Memorial Hospital/University of Rochester Medical CenterRochesterNew York
| | - Danielle Fortuna
- Department of Pathology and Laboratory MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Arezoo Ghaneie
- Associates in Hematology and Oncology, P.C.Crozer Regional Cancer CenterUplandPennsylvania
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37
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Girolami A, Cosi E, Santarossa C, Ferrari S, Girolami B, Lombardi AM. Factor X Friuli Coagulation Disorder: Almost 50 Years Later. Clin Appl Thromb Hemost 2018; 24:33-40. [PMID: 28030967 PMCID: PMC6714644 DOI: 10.1177/1076029616686423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The story of factor X (FX) Friuli. Factor X Friuli was discovered in 1969 to 1970. However, the story of that disease was an international event since patients with this defect were studied in France and in Italy, and different diagnoses were reached-FVII; FX; combined prothrombin complex; and combined FII, FVII, and FX deficiencies. The diagnostic difficulties were due to the peculiar clotting pattern presented by these patients, namely, prolonged partial thromboplastin time, prolonged prothrombin time but normal Russell viper venom clotting time. Only suitable anti-FX antisera clarified the pattern. Altogether 12 homozygotes and 102 heterozygotes have been followed during 4 decades. Six homozygotes died, 2 of them due to HIV infection and 1 due to hepatitis B liver cirrhosis. The other 3 died of nontransfusion-related morbidity. Bleeding tendency has been moderate in agreement with the extrinsic or intrinsic system assay results-FX level of 4% to 5% is considered normal. Heterozygotes may present occasional bleeding manifestations usually during surgery or delivery. Molecular analysis have shown that the mutation responsible for the defect is a Pro343Ser substitution in exon 8. Chimeric FX Friuli mice have been useful in studying the effect of FX levels on embryonic or natal mortality of these animals. No new homozygote but several heterozygotes have been recently seen. The study of FX Friuli has revolutionized the diagnostic approach to FX deficiencies. The FX should be assayed by all assay systems. The FX Friuli has never been described in any other country, and all patients studied come from the Friuli Meduna River Valley.
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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
| | - Claudia Santarossa
- Department of Medicine, University of Padua Medical School, Padua, Italy
| | - Silvia Ferrari
- Department of Medicine, University of Padua Medical School, Padua, Italy
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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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39
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Zheng F, Jin Y, Niu Z, Xu P, Xie H, Wang M. Congenital combined deficiency of factor VII and X in a patient due to accidental diphacinone intoxication. Thromb Haemost 2017; 106:180-1. [DOI: 10.1160/th10-11-0732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 04/15/2011] [Indexed: 11/05/2022]
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40
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A patient with acquired factor X deficiency and metastatic transitional cell carcinoma of the bladder: is there a link between metastasis and factor deficiency in solid tumors? Ann Hematol 2017; 97:545-546. [PMID: 29130135 DOI: 10.1007/s00277-017-3172-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 11/04/2017] [Indexed: 10/18/2022]
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41
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Complex formation with pentraxin-2 regulates factor X plasma levels and macrophage interactions. Blood 2017; 129:2443-2454. [DOI: 10.1182/blood-2016-06-724351] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 02/11/2017] [Indexed: 12/17/2022] Open
Abstract
Key Points
We have identified PTX2 as a novel partner for FX in the circulation, and their plasma levels are interdependent. FX and PTX2 cooperate with SR-AI to prevent their uptake by macrophages.
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42
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Diagnosis and Treatment of von Willebrand Disease and Rare Bleeding Disorders. J Clin Med 2017; 6:jcm6040045. [PMID: 28394285 PMCID: PMC5406777 DOI: 10.3390/jcm6040045] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 12/19/2022] Open
Abstract
Along with haemophilia A and B, von Willebrand disease (VWD) and rare bleeding disorders (RBDs) cover all inherited bleeding disorders of coagulation. Bleeding tendency, which can range from extremely severe to mild, is the common symptom. VWD, due to a deficiency and/or abnormality of von Willebrand factor (VWF), represents the most frequent bleeding disorder, mostly inherited as an autosomal dominant trait. The diagnosis may be difficult, based on a bleeding history and different diagnostic assays, which evaluate the pleiotropic functions of VWF. Different treatment options are available for optimal management of bleeding and their prevention, and long-term outcomes are generally good. RBDs are autosomal recessive disorders caused by a deficiency of any other clotting factor, apart from factor XII, and cover roughly 5% of all bleeding disorders. The prevalence of the severe forms can range from 1 case in 500,000 up to 1 in 2–3 million, according to the defect. Diagnosis is based on bleeding history, coagulation screening tests and specific factor assays. A crucial problem in RBDs diagnosis is represented by the non-linear relationship between clinical bleeding severity and residual clotting levels; genetic diagnosis may help in understanding the phenotype. Replacement therapies are differently available for patients with RBDs, allowing the successful treatment of the vast majority of bleeding symptoms.
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43
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Boudin L, Patient M, Roméo E, Bladé JS, Gisserot O, de Jauréguiberry JP. [Acquired, non-amyloid related factor X deficiency: A first case associated with atypical chronic lymphocytic leukemia and literature review]. Rev Med Interne 2017; 38:478-481. [PMID: 28110969 DOI: 10.1016/j.revmed.2016.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 09/26/2016] [Accepted: 12/15/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Acquired factor X deficiency is in most cases associated with AL amyloidosis. Acquired non-amyloid related factor X deficiency (DNAA-FX) has been exceptionally reported in the literature. CASE REPORT We report the first case of acquired, non-amyloid related factor X deficiency associated with atypical chronic lymphoid leukemia in a 66-year-old patient with spontaneous hematomas. After therapeutic failure with polyclonal intravenous immunoglobulins, specific lymphoid malignancy treatment allowed symptoms and coagulation disorder resolution. CONCLUSION DNAA-FX should be considered in case of bleeding events or coagulation disorders during low-grade hematological malignancies. Its occurrence can be considered as a treatment indication to prevent potentially fatal bleeding complications.
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Affiliation(s)
- L Boudin
- Service de médecine interne- oncologie, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France; École du Val-de-Grâce, boulevard Port-Royal, 75005 Paris, France
| | - M Patient
- Service de médecine interne- oncologie, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France; École du Val-de-Grâce, boulevard Port-Royal, 75005 Paris, France
| | - E Roméo
- Service de médecine interne- oncologie, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France
| | - J-S Bladé
- Service de médecine interne- oncologie, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France
| | - O Gisserot
- Service de médecine interne- oncologie, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France
| | - J-P de Jauréguiberry
- Service de médecine interne- oncologie, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France; École du Val-de-Grâce, boulevard Port-Royal, 75005 Paris, France.
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Gómez-Moreno G, Cutando-Soriano A, Arana C, Scully C. Hereditary Blood Coagulation Disorders: Management and Dental Treatment. J Dent Res 2016; 84:978-85. [PMID: 16246926 DOI: 10.1177/154405910508401102] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Patients with hereditary hemostatic disorders, characterized by a tendency to bleeding or thrombosis, constitute a serious challenge in the dental practice. Advances in the medical diagnosis of hemostatic disorders have exposed dental professionals to new patients not amenable to the application of the management protocols associated with other, more well-known, disorders. It is the aim of this paper to review the evidence, to highlight the areas of major concern, and to suggest management regimens for patients with hereditary hemostatic disorders. An extensive review has been made (PubMed, Science Direct, Web of Knowledge, etc.) of literature pertaining to hereditary disorders affecting blood coagulation factors and how they affect the practice of dentistry. Several aspects relating to the care of such patients must be recognized and taken into consideration when dental treatment is planned. Replacement of deficient coagulation factors ensures that safe dental treatment will be carried out. However, the half-life of such coagulation factors requires that dental treatment be specifically planned and adapted to the type of pathology involved.
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Affiliation(s)
- G Gómez-Moreno
- Department of Special Care in Dentistry, School of Dentistry, University of Granada, Colegio Máximo s/n, Campus de Cartuja, E-18071 Granada, Spain
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Shapiro A. Plasma-derived human factor X concentrate for on-demand and perioperative treatment in factor X-deficient patients: pharmacology, pharmacokinetics, efficacy, and safety. Expert Opin Drug Metab Toxicol 2016; 13:97-104. [DOI: 10.1080/17425255.2016.1237504] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Hawke L, Grabell J, Sim W, Thibeault L, Muir E, Hopman W, Smith G, James P. Obstetric bleeding among women with inherited bleeding disorders: a retrospective study. Haemophilia 2016; 22:906-911. [PMID: 27704714 DOI: 10.1111/hae.13067] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2016] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Women with inherited bleeding disorders are at increased risk for bleeding complications during pregnancy and the postpartum period, particularly postpartum haemorrhage (PPH). AIM This retrospective study evaluates pregnancy management through the Inherited Bleeding Disorders Clinic of Southeastern Ontario, the clinical factors associated with pregnancy-related abnormal bleeding and assesses tranexamic acid use in the postpartum treatment of bleeding disorder patients. METHODS A chart review of 62 pregnancies, from 33 women, evaluated patient characteristics (age, haemostatic factor levels) and delivery conditions (mode of delivery, postpartum treatment) in relation to abnormal postpartum bleeding. RESULTS This cohort revealed increased risk of immediate PPH with increased age at delivery (mean age: 30.1 years with PPH, 26.5 years without PPH, P < 0.013), and birth by vaginal delivery (P < 0.042). Low von Willebrand factor (VWF) antigen or factor VIII (FVIII) in the third trimester was not associated with an increased risk of PPH; however, low VWF:RCo was associated with increased immediate PPH despite treatment with continuous factor infusion (P < 0.042). Women treated with tranexamic acid postpartum had less severe bleeding in the 6-week postpartum (P < 0.049) with no thrombotic complications. CONCLUSIONS This study contributes to the growing body of work aimed at optimizing management of bleeding disorder patients through pregnancy and the postpartum period, showing patients are at a higher risk of PPH as they age. Risk factors such as low third trimester VWF:RCo have been identified. Treatment with tranexamic acid in the postpartum period is associated with a reduced incidence of abnormal postpartum bleeding.
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Affiliation(s)
- L Hawke
- Queen's University, Kingston, ON, Canada
| | - J Grabell
- Queen's University, Kingston, ON, Canada
| | - W Sim
- Queen's University, Kingston, ON, Canada
| | - L Thibeault
- Kingston General Hospital, Kingston, ON, Canada
| | - E Muir
- Queen's University, Kingston, ON, Canada
| | - W Hopman
- Queen's University, Kingston, ON, Canada
| | - G Smith
- Queen's University, Kingston, ON, Canada
| | - P James
- Queen's University, Kingston, ON, Canada.,Kingston General Hospital, Kingston, ON, Canada
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Girolami A, Cosi E, Santarossa C, Ferrari S, Girolami B, Lombardi AM. Prevalence of bleeding manifestations in 128 heterozygotes for Factor X deficiency, mainly for FX Friuli, matched versus 128 unaffected family members, during a long sequential observation period (23.5 years). Eur J Haematol 2016; 97:547-553. [DOI: 10.1111/ejh.12767] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 11/27/2022]
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
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A family with factor X deficiency from Argentina: a compound heterozygosis because of the combination of a new mutation (Gln138Arg) with an already known one (Glu350Lys). Blood Coagul Fibrinolysis 2016; 27:732-6. [PMID: 27031279 DOI: 10.1097/mbc.0000000000000563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective was to investigate a family from Argentina. The proposita was a 51-year-old woman who had a moderate bleeding tendency. Some of her children showed a mild bleeding tendency. Her mother and the husband were asymptomatic. Clotting, immunological and molecular biology techniques were used. Partial thromboplastin, prothrombin, Russell Viper venom-clotting times were moderately prolonged in the proposita, whereas they were slightly prolonged in the children and in her mother. Factor X (FX) activity was about 2-3% of normal in all assay systems. FX antigen was less than 5%. Other clotting factors and platelet were normal. Genetic analysis showed a compound heterozygosis: combination of a 'new' mutation (Gln138Arg) with an already known mutation (Glu350Lys). The children had intermediate FX levels (35-63% of normal) and were carriers of one of the two mutations present in the proposita. This is the first observation of a FX deficiency in Argentina.
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Spectrum of factor X gene mutations in Iranian patients with congenital factor X deficiency. Blood Coagul Fibrinolysis 2016; 27:324-7. [DOI: 10.1097/mbc.0000000000000435] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sun N, Chen Y, Peng H, Luo Y, Zhang G. A novel Ala275Val mutation in factor X gene influences its structural compatibility and impairs intracellular trafficking and coagulant activity. Thromb Res 2016; 138:108-113. [DOI: 10.1016/j.thromres.2015.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/16/2015] [Accepted: 12/12/2015] [Indexed: 11/25/2022]
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