Acquired inhibitor of factor V: first report in China and literature review

Development of acquired factor V inhibitor after treatment with ceftazidime: a case report and review of the literature

We report the case of a 59-year-old Chinese man who showed an asymptomatic coagulation factor V deficiency pattern after second intravenous treatment with ceftazidime. Normal pooled plasma failed to correct the abnormalities in a mixing test, and the presence of factor V inhibitor was confirmed by the Bethesda method. The coagulopathy was not corrected by transfusion of fresh frozen plasma and prothrombin complex concentrate, but rather by treatment with prednisone and withdrawal of dubious drugs. The findings reported here should prompt clinicians to watch for drug-induced coagulation factor deficiency.

Acquired factor V inhibitors: a systematic review

The occurrence of an inhibitor against coagulation factor V (FV) is a rare but challenging condition, which may span from asymptomatic laboratory abnormalities to potentially life-threatening bleeding. The onset of FV inhibitors has been associated most frequently in the past with the patients' exposure to topical bovine thrombin administered during surgery procedures. However, since this preparation is no longer used, in this systematic review we have only focused on non-bovine thrombin-related FV inhibitor cases.

Acquired factor V inhibitor in a critically ill patient

Acquired inhibitor of factor V is a rare condition with a variety of clinical manifestations, from extremely mild to life threatening haemorrhage. We present a case from our intensive care unit as a reminder of the less common causes of elevated prothombin and activated partial thromboplastin times, and how knowledge of the variable presentation may aid management.

Spontaneous resolution of acquired factor V inhibitor associated with ovarian carcinoma

A 74-year-old lady who presented initially with loin pain and haematuria, then melaena was found to have a prothrombin time ratio (PTR) > 10 and activated partial thromboplastin time ratio (APTTR) > 7. A factor V inhibitor was diagnosed. She was managed with supportive care and the FV inhibitor resolved. A few weeks later she developed abdominal swelling and ascites and was found to have an ovarian tumour. This is the first case, as far as we are aware, of a malignancy-associated FV antibody that has spontaneously remitted before overt presentation of the tumour and illustrates the value of adopting an expectant approach to the management of acquired FV inhibitors.

Spectrum of bleeding in acquired factor V inhibitor: a summary of 33 cases

Coagulation factor V (FV) is an essential component of the prothrombinase complex, which activates the zymogen prothrombin to thrombin. Acquired FV inhibitor is rare and clinical symptoms are quite variable. The aim of this study was to summarize the spectrum of the bleeding presentation of acquired FV deficiency and characterize the underlying causes of the clinical symptoms. This study was designed as a descriptive retrospective and 30 case reports were included for further analysis. At least 33 cases of acquired FV inhibitor were investigated. Most patients have a presentation of bleeding and most of those are from hematuria and bleeding at surgical sites. Seven cases of asymptomatic acquired FV inhibitor were also detected. A total of 39.4% (19 of 33) of those cases with acquired FV inhibitor have an unknown cause. For those with known etiologies, chemical and drug-induced causes are the most common (30.8%).

Acquired coagulation inhibitor-associated bleeding disorders: an update

Acquired blood coagulation inhibitors are circulating immunoglobulins that neutralize the activity of a specific coagulation protein or accelerate its clearance from the plasma, thus causing a bleeding tendency. In this review, we focus on the nonhemophilic inhibitors of coagulation, i.e. the autoantibodies occurring in individuals without a pre-existent coagulation defect, reporting the most recent advances in the pathophysiology, diagnosis and treatment of these rare acquired bleeding disorders.

[Acquired factor V inhibitors in a polytraumatized patient]

BACKGROUND

Factor V (FV) inhibitors are a rare disorder reported for the first time about fifty years ago, mostly with the unknown cause. The appearance of FV inhibitors is usually preceded by surgery, infections, administration of antibiotics or transfusions. Clinical manifestations of the presence of FV inhibitors vary from mild to severe and in some instances fatal hemorrhage.

CASE REPORT

A healthy 51-year-old man with severe multiple injuries (traffic accident), and hemorrhage, which ocurred during the orthopedic treatment, was admitted with hemoptysis, epistaxis and hematoma of the right upper leg, and with prolonged prothrombin time (PT), and activated partial thromboplastin time (aPTT). Treatment with vitamin K, fresh-frozen plasma and cryoprecipitate stopped the hemorrhage, but the results of coagulation tests were not normalized. The correction of aPTT and PT with normal plasma showed the decreased activity of FV (1%) due to the presence of inhibitors (titer 17.5 IU). The abnormal resuts of coagulation tests remained for three weeks, but without clinically manifested hemorrhagic syndrome. At the fourth week after the appearance of FV inhibitors PT, aPTT and the activity of FV became normal and antibodies disappeared spontaneously.

CONCLUSION

Our patient with polytrauma developed a mild hemorrhagic syndrome due to the presence of FV inhibitors five weeks after the accident. Hemorrhage was treated with substitution therapy. The cause of the development of FV inhibitors was unclear ("fibrin glue" was not used during the orthopedic treatment). Factor V inhibitors disappeared spontaneously within four weeks. The fast spontaneous disappearance of FV inhibitors in our patient, confirmed the observations of some authors that they disappeared faster in those patients who were surgically treated prior to their appearance.