1
|
Bounaix L, Schroeder V, Fontana P, Casini A. Management of anticoagulation and factor XIII replacement in a patient with severe factor XIII deficiency and recurrent venous thromboembolic disease: case report and review of literature. Res Pract Thromb Haemost 2024; 8:102371. [PMID: 38595334 PMCID: PMC11002293 DOI: 10.1016/j.rpth.2024.102371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/23/2024] [Accepted: 03/07/2024] [Indexed: 04/11/2024] Open
Abstract
Background Thrombotic events in congenital factor (F)XIII deficiency are extremely rare. To our knowledge, we describe the first case of severe congenital FXIII deficiency associated with recurrent venous thrombotic events. Key Clinician Question How to deal with anticoagulation treatment in patients with severe FXIII deficiency? Clinical Approach The patient was treated with rivaroxaban and plasma-derived FXIII substitution therapy as prophylaxis without bleeding complications. We aimed at FXIII trough levels of 50% during the loading doses of rivaroxaban, then 30% during the maintenance dose of rivaroxaban, and finally 20% during the long-term use of prophylactic dose of rivaroxaban. Conclusion Treatment of thrombotic events with rivaroxaban in patients with severe bleeding disorders seems to be safe, requiring an adaptation of the intensity of the replacement therapy.
Collapse
Affiliation(s)
- Laura Bounaix
- Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Verena Schroeder
- Experimental Haemostasis Group, Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Pierre Fontana
- Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Alessandro Casini
- Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| |
Collapse
|
2
|
Smith J, Bodine JS, Cunningham MT, Gooley K, Plapp FV, Dasgupta A, Ye Z. Perioperative therapeutic plasma exchange in a patient with rare Factor XIII inhibitor. Transfus Apher Sci 2023:103654. [PMID: 36775674 DOI: 10.1016/j.transci.2023.103654] [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: 07/20/2022] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Factor XIII deficiency is a rare bleeding disorder which could be severe if inherited or less severe if acquired. We report a case of acquired Factor XIII inhibitor in a 75-year-old male with a suspicious left renal mass treated perioperatively with therapeutic plasma exchange (TPE). PATIENT AND METHOD To perform kidney biopsy and ablation of the renal mass, six daily TPE treatments were performed before and after biopsy to minimize bleeding risk because the patient did not respond to drug therapy. Both thromboelastography (TEG) and laboratory-based coagulation tests were performed to assess coagulation status prior to and after TPE. RESULTS The biopsy indicated oncocytoma which was removed by surgical procedure. Factor XIII activity remained below 15 % throughout TPE treatments, but Factor XIII inhibitor titer reduced from initial positive value of 1:40 to negative following the third TPE and remained negative through the sixth TPE. Unfortunately, the inhibitor titer was positive at 1:20 in the fifth month and 1:5 in the sixth month during follow-up. CONCLUSIONS TPE is useful in removing XIII inhibitory factor, but the effects are only short term.
Collapse
Affiliation(s)
- Joshua Smith
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jared S Bodine
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Mark T Cunningham
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Kathleen Gooley
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Frederick V Plapp
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Amitava Dasgupta
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Zhan Ye
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, United States.
| |
Collapse
|
3
|
Souri M, Ozawa T, Osaki T, Koyama T, Muraguchi A, Ichinose A. Cloning of human anti-factor XIII monoclonal antibody dissects mechanisms of polyclonal antibodies in a single patient. JOURNAL OF THROMBOSIS AND HAEMOSTASIS : JTH 2023; 21:255-268. [PMID: 36700504 DOI: 10.1016/j.jtha.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/28/2022] [Accepted: 11/13/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Coagulation factor XIII (FXIII) consists of 2 A (FXIII-A) and 2 B (FXIII-B) subunits that cross-link and strengthen the hemostatic fibrin thrombus; thus, abnormal bleeding occurs when FXIII is significantly reduced. Autoimmune-acquired FXIII deficiency (AiF13D) is characterized by lethal bleeding secondary to the development of autoantibodies against FXIII. However, since anti-FXIII autoantibodies are polyclonal, the mechanism underlying FXIII dysfunction is unclear. OBJECTIVES The objective of this study was to dissect the inhibitory mechanisms of polyclonal anti-FXIII autoantibodies. METHODS In this study, we prepared the human monoclonal antibodies (hmAbs) from the peripheral blood of an 86-year-old man with AiF13D by using a new complementary DNA cloning method and analyzed the properties of each autoantibody. RESULTS Seventeen clones obtained from hmAbs were divided into the following 3 groups: dissociation inhibitors of FXIII-A2B2 (6 clones), assembly inhibitors of FXIII-A2B2 (3 clones), and nonneutralizing/inhibitory hmAbs (8 clones). Dissociation inhibitors strongly inhibited fibrin cross-linking and amine incorporation. Assembly inhibitors extracted FXIII-A from FXIII-A2B2, strongly inhibited binding of FXIII-A to FXIII-B, and activation peptide cleavage. However, the patient's plasma presented a strong inhibition of A2B2 heterodimer assembly but only a slight inhibition of thrombin-Ca2+-dependent dissociation, suggesting that the assembly inhibitors concealed the effect of dissociation inhibitors in plasma. By contrast, nonneutralizing antibodies had little effect on the function of FXIII, suggesting that nonneutralizing hmAbs (and/or dissociation inhibitors and/or assembly inhibitors) promoted the clearance of FXIII-A from the blood. CONCLUSION Cloning of anti-FXIII autoantibodies enabled us to not only elucidate the mechanism and pathophysiology of AiF13D but also develop a completely new type of anticoagulant.
Collapse
Affiliation(s)
- 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, Tokyo, Japan; Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science, 2-2-2, Iida-Nishi, Yamagata, Japan
| | - Tatsuhiko Ozawa
- Department of Immunology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, 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, Tokyo, Japan
| | - Takatoshi Koyama
- Department of Hematology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Muraguchi
- Department of Immunology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - 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, Tokyo, Japan.
| |
Collapse
|
4
|
Ichinose A, Osaki T, Souri M. Pathological coagulation parameters in as many as 54 patients with autoimmune acquired factor XIII deficiency due to anti-factor XIII autoantibodies. Haemophilia 2021; 27:454-462. [PMID: 33847063 DOI: 10.1111/hae.14298] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Autoimmune factor XIII (FXIII) deficiency (AiF13D) due to anti-FXIII autoantibodies is an extremely rare, life-threatening bleeding disorder that mostly occurs in the elderly. The number of patients diagnosed with AiF13D has been increasing in Japan, probably because of the nationwide survey on AiF13D supported by the Japanese Ministry of Health, Labour and Welfare. AIM To explore the pathologic characteristics of coagulation parameters in AiF13D. METHODS AiF13D-suspected cases were consulted, and underwent unified/integrated coagulation screening and were definitively diagnosed as AiF13D separately. RESULTS AiF13D patients had lower FXIII antigen levels than non-AiF13D patients, but their values overlapped. Among a series of 22-item screening tests and their resulting parameters, the 'FXIII inhibitory potential' yielded by a 1:1 mixing test of the patient's and healthy control's plasma and its 'residual FXIII activity' in 54 AiF13D cases were most distinguishable from 139 non-AiF13D cases, followed by FXIII activity per se and FXIII-specific activity. While the cross-linked α2 -plasmin inhibitor level reduced, the levels of D-dimer, fibrin/fibrinogen degradation products and plasmin-plasmin inhibitor complex increased, probably because the patients' haematoma nonspecifically induced secondary fibrinolysis in both AiF13D and non-AiF13D patients. CONCLUSION AiF13D appears to induce a hypocoagulopathy combined with a hyper-fibrinolytic state secondary to severe FXIII deficiency caused by anti-FXIII autoantibodies, and the consequent bleeding further modifies its pathological conditions. In addition, the 1:1 mixing test of FXIII activity was confirmed to be a reliable screening method for AiF13D, especially when its derivative parameter, such as the 'FXIII inhibitory potential' or 'FXIII inhibitory potential ratio', is employed.
Collapse
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), Yamagata, 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), Yamagata, Japan.,Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science, 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), Yamagata, Japan.,Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science, Yamagata, Japan
| |
Collapse
|
5
|
Marco A, Marco P. Autoimmune Acquired Factor XIII Deficiency: A Case Report. J Blood Med 2021; 12:63-68. [PMID: 33603527 PMCID: PMC7882714 DOI: 10.2147/jbm.s288634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/29/2020] [Indexed: 11/23/2022] Open
Abstract
Autoimmune acquired factor XIII (FXIII) deficiency is a rare disorder characterized by severe spontaneous hematomas and autoantibodies against FXIII. High mortality rates have been reported (18% within a year of diagnosis). We present a 70-year-old patient with recurrent muscular hematomas. The basic hemostasis study and the coagulation factors were within normal ranges. The aggregation platelet study was also normal and von Willebrand disease was excluded. Bearing in mind the recurrent bleeding history and the described laboratory results, we considered a FXIII deficiency, that was confirmed (FXIII<10%). In addition, we suspected an acquired FXIII deficiency since the patient did not report a personal or family history of bleeding and FXIII gene sequencing study was normal. Non-immune causes were ruled out, and plasma autoantibodies against FXIII were detected. Immunosuppression was rapidly initiated to eradicate inhibitor as was hemostatic treatment to obtain bleeding control. Currently, the patient is asymptomatic, but a low level of FXIII inhibitor remains.
Collapse
Affiliation(s)
- Ana Marco
- Thrombosis and Hemostasis Department, Hematology Service, University General Hospital in Alicante, Alicante, Spain.,Biomedical Health Research Institute, University General Hospital in Alicante, Alicante, Spain
| | - Pascual Marco
- Thrombosis and Hemostasis Department, Hematology Service, University General Hospital in Alicante, Alicante, Spain.,Biomedical Health Research Institute, University General Hospital in Alicante, Alicante, Spain.,Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain
| |
Collapse
|
6
|
Ferretti A, Baldacci E, Fazio F, Abbruzzese R, Barone F, De Luca ML, Petrucci MT, Chistolini A, Mazzucconi MG, Santoro C. Acquired FXIII deficiency and AL amyloidosis: A case of a rare association. Transfus Apher Sci 2020; 59:102903. [PMID: 32839100 DOI: 10.1016/j.transci.2020.102903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 11/19/2022]
Affiliation(s)
- A Ferretti
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy.
| | - E Baldacci
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - F Fazio
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - R Abbruzzese
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - F Barone
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - M L De Luca
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - M T Petrucci
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - A Chistolini
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - M G Mazzucconi
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - C Santoro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| |
Collapse
|
7
|
Acquired FXIII inhibitor: Patient characteristics and treatment outcome, a case series in Taiwan. J Formos Med Assoc 2020; 120:411-414. [PMID: 32513506 DOI: 10.1016/j.jfma.2020.05.032] [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: 03/05/2020] [Revised: 04/29/2020] [Accepted: 05/21/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Acquired factor XIII (FXIII) inhibitor is a rare but possibly underdiagnosed bleeding disorder. To date, less than one hundred cases have been reported, but the number has increased rapidly in recent years, especially in Japan. Because of the rarity of this disorder, no treatment guidelines are available. In some reports, physicians treated the bleeding with cryoprecipitate or factor XIII concentrate and eradicated the inhibitor with various immune suppressants. METHODS From January 2015 to December 2018, we collected consecutive patients diagnosed as having acquired FXIII inhibitor. FXIII activity and inhibitor were measured by a fluorescent factor XIII assay using isopeptidase reaction catalyzed by activated factor XIII and the Bethesda method, respectively. Factor XIII antigen was measured by latex-enhanced immunoassay. RESULTS We found five adult patients with detectable FXIII inhibitor. Four of them were older than 70. Two had systemic lupus erythematosus. All the patients presented with ecchymosis and intramuscular hematoma. No life-threatening bleeding was observed. Delayed diagnosis was common with varied time periods needed to achieve a correct diagnosis. All bleedings were treated and improved by cryoprecipitate. Steroids were given to all patients and cyclophosphamide, rituximab, and other immune suppressants were also used. FXIII inhibitor was totally resolved in three, partially resolved in one, and persisted in one patient. CONCLUSION We documented five patients with acquired FXIII inhibitor, found over 4 years. The most common presentations were ecchymosis and intramuscular hematomas. Cryoprecipitate was effective in controlling most bleeds. Steroid, cyclophosphamide and rituximab were effective in eradicating inhibitor in some patients.
Collapse
|
8
|
Bovet J, Hurják B, De Maistre E, Katona É, Pénzes K, Muszbek L. Autoimmune factor XIII deficiency with unusual laboratory and clinical phenotype. J Thromb Haemost 2020; 18:1330-1334. [PMID: 32311817 DOI: 10.1111/jth.14811] [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: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 11/29/2022]
Abstract
Hemorrhagic diathesis due to anti-factor XIII (FXIII) autoantibody is a rare but severe disorder. Challenges of the diagnosis and treatment is demonstrated by the case of a 67-year-old female without previous bleeding history, who suffered a huge muscular hematoma. Without blank subtraction 18% plasma FXIII activity was measured; however, after correction for blank the activity was below the limit of detection and the lack of fibrin cross-linking in the patient's plasma confirmed the latter result. FXIII-A2 antigen was not detectable by enzyme-linked immunosorbent assay (ELISA); however, it was well detected by western blotting. The autoantibody showed high affinity toward FXIII-A2 . Its considerable inhibitory activity was demonstrated by high titer in Bethesda units and the low immunoglobulin G concentration required for inhibition. The main biochemical effect was the inhibition of Ca2+ -induced activation. Eradication therapy was only partially successful. Four months after the last hemorrhagic event the patient suffered deep vein thrombosis complicated by pulmonary embolism.
Collapse
Affiliation(s)
- Julien Bovet
- Hemophilia Care Center University Hospital of Dijon, Dijon, France
| | - Boglárka Hurják
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, Debrecen, Hungary
| | | | - Éva Katona
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Krisztina Pénzes
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Muszbek
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| |
Collapse
|
9
|
Franchini M, Marano G, Cruciani M, Mengoli C, Pati I, Masiello F, Veropalumbo E, Pupella S, Vaglio S, Liumbruno GM. Advances in managing rare acquired bleeding disorders. Expert Rev Hematol 2020; 13:599-606. [PMID: 32286895 DOI: 10.1080/17474086.2020.1756259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Rare acquired bleeding disorders include a wide spectrum of coagulopathies characterized by spontaneous or post-trauma and post-surgery hemorrhages in patients without a previous personal or family history of bleeding. AREAS COVERED This review, based on a Medline/PubMed search during the last 20 years, will focus mainly on rare acquired bleeding disorders caused by autoantibodies against coagulation factors, including autoantibodies against factor VIII (acquired hemophilia A), von Willebrand factor (acquired von Willebrand syndrome) and other coagulation factors (factors V, X, XI, and XIII). The pathogenic, laboratory, and clinical features of these rare hemorrhagic conditions will be discussed, with particular attention to their management. EXPERT OPINION The treatment of rare acquired bleeding disorders includes the control of bleeding and the elimination of the autoantibody and of the underlying disease, when present. As the bleeding clinical phenotype is often severe, the management of affected patients is particularly challenging. Thus, while an early diagnosis of the acquired coagulopathy is essential to start the most appropriate treatment and to improve patients' outcomes, the support of specialized centers is equally important to provide a correct management of such complicated cases.
Collapse
Affiliation(s)
- Massimo Franchini
- Italian National Blood Centre, National Institute of Health , Rome, Italy.,Department of Hematology and Transfusion Medicine, Carlo Poma Hospital , Mantua, Italy
| | - Giuseppe Marano
- Italian National Blood Centre, National Institute of Health , Rome, Italy
| | - Mario Cruciani
- Italian National Blood Centre, National Institute of Health , Rome, Italy.,Infection Control Committee and Antibiotic Stewardship Programme, AULSS9 Scaligera , Verona, Italy
| | - Carlo Mengoli
- Italian National Blood Centre, National Institute of Health , Rome, Italy
| | - Ilaria Pati
- Italian National Blood Centre, National Institute of Health , Rome, Italy
| | - Francesca Masiello
- Italian National Blood Centre, National Institute of Health , Rome, Italy
| | - Eva Veropalumbo
- Italian National Blood Centre, National Institute of Health , Rome, Italy
| | - Simonetta Pupella
- Italian National Blood Centre, National Institute of Health , Rome, Italy
| | - Stefania Vaglio
- Italian National Blood Centre, National Institute of Health , Rome, Italy
| | | |
Collapse
|
10
|
Di Micco P, Gussoni G, Pieralli F, Campanini M, Dentali F, Fontanella A. Acquired Factor XIII Deficiency Inducing Recurrent and Fatal Bleeding, Description of a Case. J Blood Med 2020; 11:43-45. [PMID: 32099500 PMCID: PMC6996541 DOI: 10.2147/jbm.s232115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/03/2019] [Indexed: 12/03/2022] Open
Abstract
Factor XIII deficiency may be inherited or acquired. Inherited deficiency is associated with signs and symptoms of minor bleeding from a young age, and possible major bleeding complications, in particular during pregnancy. On the other hand, acquired factor XIII deficiency is usually associated with severe symptoms of major bleeding, in particular during surgery. In this paper, we report an interesting case of recurrent major bleeding with subsequent fatal bleeding in an adult man diagnosed with acquired factor XIII deficiency.
Collapse
Affiliation(s)
- Pierpaolo Di Micco
- Department of Internal Medicine and Emergency Room, Fatebenefratelli Hospital of Naples, Naples, Italy
| | | | | | - Mauro Campanini
- Department of Internal Medicine, Ospedale Maggiore, Novara, Italy
| | - Francesco Dentali
- Department of Internal Medicine, University of Insubria, Varese, Italy
| | - Andrea Fontanella
- Department of Internal Medicine and Emergency Room, Fatebenefratelli Hospital of Naples, Naples, Italy
| |
Collapse
|
11
|
Tang N, Li D, Wang X, Yang J. Concurrent hematoma and venous thrombosis in a patient with autoimmune acquired factor XIII deficiency. Int J Lab Hematol 2019; 42:e4-e6. [PMID: 31132215 DOI: 10.1111/ijlh.13053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/30/2019] [Accepted: 05/03/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Ning Tang
- Department of Clinical Laboratory, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dengju Li
- Department of Hematology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiong Wang
- Department of Clinical Laboratory, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jun Yang
- Department of Vascular Surgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| |
Collapse
|
12
|
Abstract
Acquired factor XIII (FXIII) deficiency is a rare bleeding disorder that can manifest with spontaneous or delayed life-threatening hemorrhage. Causes of acquired deficiency include immune-mediated inhibition, as well as non-immune FXIII hyperconsumption or hyposynthesis. The occurrence of acquired FXIII deficiency can be idiopathic or may be associated with comorbidities, such as malignancies or autoimmune disorders. Recognition of acquired FXIII deficiency and its underlying cause is imperative, as treatment options vary depending on the etiology. Diagnosis requires quantitative FXIII testing in addition to supplemental inhibitor studies if the clinical situation suggests an immune-mediated pathophysiology. Treatment may involve FXIII replacement, antifibrinolytic administration, and/or inhibitor eradication. However, treatment targets and thresholds are undefined in acquired FXIII deficiency. This review will focus on the clinical characteristics, diagnostic issues and therapeutic options for both immune and non-immune acquired FXIII deficiency. Cases are described to illustrate the clinical features of acquired FXIII deficiency.
Collapse
Affiliation(s)
- Matthew Tak Sheng Yan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Natalia Rydz
- Division of Hematology and Hematologic Malignancies, Foothills Medical Centre, Calgary, AB, Canada
| | - Dawn Goodyear
- Division of Hematology and Hematologic Malignancies, Foothills Medical Centre, Calgary, AB, Canada
| | - Michelle Sholzberg
- St. Michael's Hospital, Room 2-007G Core Lab, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| |
Collapse
|
13
|
Beckman JD, Kasthuri RS, Wolberg AS, Ma AD. Challenges in diagnosis and management of acquired factor XIII (FXIII) inhibitors. Haemophilia 2018; 24:e417-e420. [PMID: 30144219 DOI: 10.1111/hae.13603] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 07/17/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Joan D Beckman
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Raj S Kasthuri
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alisa S Wolberg
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alice D Ma
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
14
|
Muszbek L, Pénzes K, Katona É. Auto- and alloantibodies against factor XIII: laboratory diagnosis and clinical consequences. J Thromb Haemost 2018; 16:822-832. [PMID: 29460500 DOI: 10.1111/jth.13982] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Indexed: 12/27/2022]
Abstract
Acquired FXIII deficiencies caused by autoantibodies against FXIII subunits represent rare but very severe bleeding diatheses. Alloantibodies in FXIII-deficient patients also cause life-threatening bleeding complications, but they develop extremely rarely. In this review we provide an overview of the diagnosis and classification of anti-FXIII antibodies and analyze 48 patients with autoimmune FXIII deficiency and four additional FXIII-deficient patients who developed anti-FXIII alloantibody. The patients were collected from peer-reviewed publications from which relevant data could be extracted. With the exception of two cases the antibodies were directed against FXIII-A. The difficulties in the diagnosis of FXIII deficiency in the presence of anti-FXIII antibodies are discussed and a scheme for the functional classification of the anti-FXIII antibodies is recommended. The three main categories are neutralizing and non-neutralizing antibodies and antibodies with combined effect. The methods being used for detecting and quantifying the inhibitory effect on FXIII activation and on the transglutaminase activity of activated FXIII are summarized and techniques for the classification of neutralizing anti-FXIII antibodies are outlined. The importance of clearance studies in these cases is emphasized. Binding assays, useful for the identification of non-neutralizing and combined type antibodies, were collected from the literature and their informative power is demonstrated by examples. The most frequently occurring bleeding symptoms in patients with anti-FXIII antibodies were soft tissue bleeding; intracranial bleedings also occurred, but less frequently than in inherited FXIII deficiency. Treatment of such patients is extremely challenging; the main aim should be eradication of the antibody.
Collapse
Affiliation(s)
- L Muszbek
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - K Pénzes
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - É Katona
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| |
Collapse
|
15
|
Ye L, Jiang S, Hu B. An Unexpected Cause of Recurrent Melena. Gastroenterology 2018; 154:488-490. [PMID: 29351831 DOI: 10.1053/j.gastro.2017.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/12/2017] [Accepted: 05/16/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Liansong Ye
- Department of Gastroenterology, West China Hospital, Sichuan University, Sichuan, China
| | - Shan Jiang
- Department of Gastroenterology, West China Hospital, Sichuan University, Sichuan, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Sichuan, China.
| |
Collapse
|
16
|
Ogawa Y, Mihara M, Souri M, Yanagisawa K, Hayashi T, Kobayashi N, Shimizu H, Iriuchishima H, Ishizaki T, Handa H, Osaki T, Nojima Y, Ichinose A. Complete remission achieved by steroid pulse therapy following rituximab treatment in a case with autoimmune haemorrhaphilia due to anti-factor XIII antibodies. Thromb Haemost 2017; 112:831-3. [DOI: 10.1160/th14-04-0323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 05/21/2014] [Indexed: 11/05/2022]
|
17
|
Rabik CA, Atkinson MA, Sule S, Strouse JJ. Treatment of an acquired Factor XIII inhibitor in an adolescent with systemic lupus erythematosus and renal failure. Transfusion 2017; 57:2159-2163. [DOI: 10.1111/trf.14185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 04/27/2017] [Accepted: 05/02/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Cara A. Rabik
- Department of Pediatrics, Division of Pediatric Hematology
| | | | - Sangeeta Sule
- Department of Pediatrics, Division of Pediatric Rheumatology; Johns Hopkins University; Baltimore Maryland
| | - John J. Strouse
- Department of Medicine, Division of Hematology; and the Department of Pediatrics, Division of Pediatric Hematology/Oncology; Duke University; Durham North Carolina
| |
Collapse
|
18
|
Theron A, Burcheri S, Vacheret F, Hillaire-Buys D, Sauguet P, Schved JF, Faillie JL, Biron-Andreani C. Iatrogenic acquired factor V inhibitors: A case report and review of the French pharmacovigilance database. Thromb Res 2017; 157:154-156. [PMID: 28755628 DOI: 10.1016/j.thromres.2017.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 06/02/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Alexandre Theron
- Department of Laboratory Haematology, University Hospital of Montpellier, France
| | - Sara Burcheri
- Department of Clinical Haematology, Hospital of Perpignan, France
| | | | | | - Pauline Sauguet
- Department of Laboratory Haematology, University Hospital of Montpellier, France
| | - Jean-François Schved
- Department of Laboratory Haematology, University Hospital of Montpellier, France
| | - Jean-Luc Faillie
- Department of Pharmacology, University Hospital of Montpellier, France
| | | |
Collapse
|
19
|
Ogawa Y, Yanagisawa K, Souri M, Mihara M, Naito C, Takizawa M, Ishizaki T, Mitsui T, Handa H, Osaki T, Nojima Y, Ichinose A. Successful Management of a Patient with Autoimmune Hemorrhaphilia due to Anti-Factor XIII/13 Antibodies Complicated by Pulmonary Thromboembolism. Acta Haematol 2017; 137:141-147. [PMID: 28380473 DOI: 10.1159/000455938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/09/2017] [Indexed: 11/19/2022]
Abstract
Autoimmune hemophilia-like disease (hemorrhaphilia) due to anti-factor XIII (FXIII) antibodies (AH13) is a very rare, life-threatening bleeding disorder. A 77-year-old woman developed macrohematuria and a right renal pelvic hematoma. The coagulation times were not prolonged, but FXIII activity and antigen levels were severely and moderately reduced to 9 and 29% of normal values, respectively. Accordingly, the FXIII-specific activity turned out to be low. FXIII inhibitor and anti-FXIII-A subunit autoantibodies were detected by a 1:1 crossmixing test and immunoblot and immunochromatographic assays. She was therefore diagnosed with "definite AH13" and treated with plasma-derived FXIII concentrates to arrest the hemorrhage. In addition to a highly compressed inferior vena cava by a huge renal pelvic hematoma, deep vein thrombosis (DVT) and pulmonary thromboembolism (PE) were identified by systemic computed tomography. The patient was immediately started on anticoagulation therapy with low-dose heparin. Emboli disappeared quickly, probably because under-crosslinked thrombi caused by severe FXIII deficiency are vulnerable to fibrinolysis. After about 1.5 years, anti-FXIII-A subunit autoantibodies still remained despite the use of rituximab, steroid pulse therapy, oral prednisolone, and oral cyclophosphamide treatments. In conclusion, an extremely rare AH13 case complicated by DVT and PE was successfully managed by balancing anticoagulation therapy with hemostatic therapy.
Collapse
Affiliation(s)
- Yoshiyuki Ogawa
- Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Kun M, Szuber N, Katona É, Pénzes K, Bonnefoy A, Bécsi B, Erdődi F, Rivard GE, Muszbek L. Severe bleeding diatheses in an elderly patient with combined type autoantibody against factor XIII A subunit; novel approach to the diagnosis and classification of anti-factor XIII antibodies. Haemophilia 2017; 23:590-597. [PMID: 28345289 DOI: 10.1111/hae.13205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Acquired factor XIII (FXIII) deficiency due to autoantibody is a rare, severe bleeding diathesis. Its laboratory diagnosis and classification represents a difficult task. AIM Introduction of novel approaches into the diagnosis and characterization of anti-FXIII autoantibody and demonstration of their use in the diagnosis of a patient with autoimmune FXIII deficiency. METHODS Factor XIII activity, FXIII antigen levels and the titre of anti-FXIII-A antibody were monitored throughout the course of the disease. FXIII activity was measured by ammonia release assay; FXIII-A2 B2 complex, total and free FXIII-B concentrations were determined by ELISAs. The binding constant for the interaction of the autoantibody with recombinant FXIII-A2 (rFXIII-A2 ) and FXIII-A2 B2 was determined by surface plasmon resonance (SPR). The inhibitory capacity of IgG was expressed as the concentration exerting 50% inhibition of FXIII activation/activity (IC50). The truncation of FXIII-A by thrombin was monitored by western blotting. The inhibition of Ca2+ -induced FXIII activation and active FXIII (FXIIIa) were assessed by FXIII activity assay. RESULTS The antibody bound to rFXIII-A2 and FXIII-A2 B2 with high affinity and accelerated the decay of supplemented FXIII concentrate. An IC50 value of 170.1 μg IgG·mL-1 indicated effective FXIII neutralization. The main neutralizing effect of the autoantibody was the inhibition of FXIIIa. After 2 months, due to combined therapeutic modalities, the autoantibody disappeared and FXIII activity significantly elevated. CONCLUSION The anti-FXIII-A autoantibody exerted a combined effect including inhibition of FXIIIa and acceleration of FXIII decay in the plasma. IC50 and binding constant determinations added important information to the characterization of the autoantibody.
Collapse
Affiliation(s)
- M Kun
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, University of Debrecen, Debrecen, Hungary
| | - N Szuber
- CHU Sainte-Justine, Montréal, Quebec, Canada
| | - É Katona
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, University of Debrecen, Debrecen, Hungary
| | - K Pénzes
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, University of Debrecen, Debrecen, Hungary.,Vascular Biology, Thrombosis and Hemostasis Research Group of the Hungarian Academy of Sciences, University of Debrecen, Debrecen, Hungary
| | - A Bonnefoy
- CHU Sainte-Justine, Montréal, Quebec, Canada
| | - B Bécsi
- Department of Medical Chemistry, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - F Erdődi
- Department of Medical Chemistry, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - G E Rivard
- CHU Sainte-Justine, Montréal, Quebec, Canada
| | - L Muszbek
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, University of Debrecen, Debrecen, Hungary.,Vascular Biology, Thrombosis and Hemostasis Research Group of the Hungarian Academy of Sciences, University of Debrecen, Debrecen, Hungary
| |
Collapse
|
21
|
Nixon CP, Prsic EH, Guertin CA, Stevenson RL, Sweeney JD. Acquired Factor XIII inhibitor associated with mantle cell lymphoma. Transfusion 2016; 57:694-699. [PMID: 27917497 DOI: 10.1111/trf.13947] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/05/2016] [Accepted: 10/05/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acquired Factor (F)XIII deficiency is a very rare bleeding diathesis with a potentially fatal outcome, previously described in the context of autoimmune disorders and leukemias. There is minimal information on autoantibody characterization and the role of antifibrinolytic therapy in patient management. CASE REPORT A 79-year-old woman with a 3-month history of bruising and heavy menorrhagia presented with ongoing vaginal bleeding, symptomatic anemia, and a right thigh hematoma. Initial management included an axillary lymph node biopsy and coagulation evaluation. Pathologic examination of the biopsy specimen revealed mantle cell lymphoma. Clot solubility assay was consistent with a FXIII activity of less than 3%. An anti-FXIII inhibitor was suspected, the epitope specificity of which was mapped by micropeptide array analysis to regions in the β-sandwich and catalytic core domain of the FXIII-A subunit. Management with cryoprecipitate, steroids, rituximab, and antifibrinolytic therapy resolved the bleeding diathesis and suppressed the inhibitor. CONCLUSION This is the first reported case of an acquired FXIII inhibitor associated with mantle cell lymphoma in which the epitope specificity of the pathologic autoantibody was accurately defined. Antifibrinolytic therapy played a prominent role in the prevention of bleeding complications in the window period between initiation of immunosuppression and disappearance of the pathologic anti-FXIII autoantibody.
Collapse
Affiliation(s)
- Christian P Nixon
- Center for International Health Research, Rhode Island Hospital and Alpert Medical School of Brown University
| | - Elizabeth H Prsic
- Department of Hematology & Oncology, Rhode Island Hospital and The Miriam Hospitals
| | | | - Ryan L Stevenson
- Department of Hematology & Oncology, Rhode Island Hospital and The Miriam Hospitals
| | - Joseph D Sweeney
- Department of Transfusion Medicine, Rhode Island Hospital and The Miriam Hospitals, Alpert Medical School of Brown University, Providence, Rhode Island
| |
Collapse
|
22
|
Autoimmune acquired factor XIII deficiency due to anti-factor XIII/13 antibodies: A summary of 93 patients. Blood Rev 2016; 31:37-45. [PMID: 27542511 DOI: 10.1016/j.blre.2016.08.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/14/2016] [Accepted: 08/02/2016] [Indexed: 11/22/2022]
Abstract
Autoimmune acquired factor XIII (F13) deficiency or autoimmune hemophilia-like disease (hemorrhaphilia) resulted from the generation of anti-F13 antibodies (AH13) is a severe bleeding disorder that occurs mainly in the elderly. Although rare, the number of patients diagnosed with AH13 has recently increased. To improve understanding of this disease, the author summarized 93 ever reported/diagnosed AH13 cases. About 50% of cases were idiopathic. In the remaining half of the patients, autoimmune diseases and malignancies were the most common underlying diseases. Intramuscular and subcutaneous bleeding were the most frequently reported symptoms. Hemorrhage was the cause of death in 13 patients. In 4 patients, the diagnosis was established after hemorrhagic death. Therefore, physicians/hematologists must raise the awareness of AH13 as a life-threatening disease. Most patients were treated with F13 concentrates to arrest bleeding and with prednisolone and cyclophosphamide to eradicate anti-F13 autoantibodies. AH13 cases tend to become chronic and intractable and require close follow-up over an extended period.
Collapse
|
23
|
Solomon C, Korte W, Fries D, Pendrak I, Joch C, Gröner A, Birschmann I. Safety of Factor XIII Concentrate: Analysis of More than 20 Years of Pharmacovigilance Data. Transfus Med Hemother 2016; 43:365-373. [PMID: 27781024 DOI: 10.1159/000446813] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 01/11/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Plasma-derived factor XIII (FXIII) concentrate is an effective treatment for FXIII deficiency. We describe adverse drug reactions (ADRs) reported during pharmacovigilance monitoring of Fibrogammin®/Corifact® and review published safety data. METHODS Postmarketing safety reports recorded by CSL Behring from June 1993 to September 2013 were analyzed. Clinical studies published during the same period were also reviewed. RESULTS Commercial data indicated that 1,653,450,333 IU FXIII concentrate were distributed over the review period, equivalent to 1,181,036 doses for a 70 kg patient. 75 cases were reported (one/15,700 standard doses or 22,046,000 IU). Reports of special interest included 12 cases of possible hypersensitivity reactions (one/98,400 doses or 137,787,500 IU), 7 with possible thromboembolic events (one/168,700 doses or 236,207,200 IU), 5 of possible inhibitor development (one/236,200 doses or 330,690,100 IU), and 20 of possible pathogen transmission (one/59,100 doses or 82,672,500 IU). 19 pathogen transmission cases involved viral infection; 4 could not be analyzed due to insufficient data, but for all others a causal relationship to the product was assessed as unlikely. A review of published literature revealed a similar safety profile. CONCLUSION Assessment of ADRs demonstrated that FXIII concentrate carries a low risk of ADRs across various clinical situations, suggesting a favorable safety profile.
Collapse
Affiliation(s)
- Cristina Solomon
- Medical Affairs Acquired Bleeding Disorders, CSL Behring, Marburg, Germany
| | - Wolfgang Korte
- Hemostasis and Hemophilia Center; and Center for Laboratory Medicine, St. Gallen, Switzerland
| | - Dietmar Fries
- Department of Anesthesia and Intensive Care, Medical University Innsbruck, Innsbruck, Austria
| | | | | | | | - Ingvild Birschmann
- Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Center, Ruhr-University Bochum, Bad Oeynhausen, Germany
| |
Collapse
|
24
|
Pénzes K, Rázsó K, Katona É, Kerényi A, Kun M, Muszbek L. Neutralizing autoantibody against factor XIII A subunit resulted in severe bleeding diathesis with a fatal outcome - characterization of the antibody. J Thromb Haemost 2016; 14:1517-20. [PMID: 27208811 DOI: 10.1111/jth.13367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Indexed: 11/30/2022]
Abstract
UNLABELLED Essentials Autoantibody against factor XIII (FXIII) is a rare but severe acquired hemorrhagic diathesis. In an elderly patient, anti-FXIII-A antibody led to severe bleedings with fatal outcome. The neutralizing autoantibody bound to FXIII with high affinity (Ka≈10(9) m(-1) ). The dominant effect of the autoantibody was the inhibition of activated FXIII. SUMMARY Autoantibodies may develop against the catalytic A subunit of factor XIII (FXIII-A) or the carrier B subunit (FXIII-B). Autoimmune FXIII-A deficiency was diagnosed in an elderly (75 years) patient with severe bleeding symptoms. The patient had 3% FXIII activity, and unmeasurable FXIII-A2 B2 and FXIII-A antigens in the plasma, whereas, in the platelet lysate, activity and FXIII-A antigen values were normal. As revealed by western blotting, FXIII antigen was present in the plasma, but the autoantibody interfered with the immunoassays. A mixing study indicated the presence of inhibitor with a titer of 63.2 Bethesda units (BU). The patient's IgG bound to FXIII-A2 B2 and to FXIII-A2 with equally high affinity (Ka in the range of 10(9) m(-1) ). It exerted a multiple inhibitory effect on FXIII activation/activity (IC50: 50 μg mL(-1) ). Immunosupressive therapy gradually decreased the autoantibody titer to 8.0 BU, but FXIII activity remained very low, and, owing to recurrent bleeding, the patient died.
Collapse
Affiliation(s)
- K Pénzes
- Division of Clinical Laboratory Science, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - K Rázsó
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - É Katona
- Division of Clinical Laboratory Science, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - A Kerényi
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - M Kun
- Division of Clinical Laboratory Science, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - L Muszbek
- Division of Clinical Laboratory Science, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Vascular Biology, Thrombosis and Hemostasis Research Group of the Hungarian Academy of Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| |
Collapse
|
25
|
Tone KJ, James TE, Fergusson DA, Tinmouth A, Tay J, Avey MT, Kilty S, Lalu MM. Acquired Factor XIII Inhibitor in Hospitalized and Perioperative Patients: A Systematic Review of Case Reports and Case Series. Transfus Med Rev 2016; 30:123-31. [DOI: 10.1016/j.tmrv.2016.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
|
26
|
Kojima M, Ichinose A, Souri M, Osaki T, Kawai H, Amaki J, Numata H, Miyamoto M, Ogiya D, Tsuboi K, Ogawa Y, Ozawa S, Ando K. Successful bypass surgery for esophageal carcinoma under adequate factor XIII/13 replacement therapy in a case of intractable autoimmune hemorrhaphilia due to anti-Factor XIII/13 antibodies. Int J Hematol 2015; 103:341-7. [DOI: 10.1007/s12185-015-1917-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/16/2015] [Accepted: 11/18/2015] [Indexed: 11/28/2022]
|
27
|
Pénzes K, Vezina C, Bereczky Z, Katona É, Kun M, Muszbek L, Rivard GE. Alloantibody developed in a factor XIII A subunit deficient patient during substitution therapy; characterization of the antibody. Haemophilia 2015; 22:268-275. [DOI: 10.1111/hae.12786] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Affiliation(s)
- K. Pénzes
- Division of Clinical Laboratory Science; Department of Laboratory Medicine; Medical and Health Science Center; University of Debrecen; Debrecen Hungary
| | - C. Vezina
- CHU Sainte-Justine; Montréal QC Canada
| | - Z. Bereczky
- Division of Clinical Laboratory Science; Department of Laboratory Medicine; Medical and Health Science Center; University of Debrecen; Debrecen Hungary
| | - É. Katona
- Division of Clinical Laboratory Science; Department of Laboratory Medicine; Medical and Health Science Center; University of Debrecen; Debrecen Hungary
| | - M. Kun
- Division of Clinical Laboratory Science; Department of Laboratory Medicine; Medical and Health Science Center; University of Debrecen; Debrecen Hungary
| | - L. Muszbek
- Division of Clinical Laboratory Science; Department of Laboratory Medicine; Medical and Health Science Center; University of Debrecen; Debrecen Hungary
- Vascular Biology, Thrombosis and Hemostasis Research Group of the Hungarian Academy of Sciences; University of Debrecen; Debrecen Hungary
| | | |
Collapse
|
28
|
Acquired inhibitors of clotting factors: AICE recommendations for diagnosis and management. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 13:498-513. [PMID: 26192778 DOI: 10.2450/2015.0141-15] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
29
|
Sen I, Selvaraj D, Premkumar P, Agarwal S. Nonhemophiliac musculoskeletal pseudotumor. J Vasc Surg Cases 2015; 1:187-190. [PMID: 31724593 PMCID: PMC6849987 DOI: 10.1016/j.jvsc.2015.04.007] [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: 01/16/2015] [Accepted: 04/28/2015] [Indexed: 11/20/2022] Open
Abstract
A 24-year-old man presented with impending ulceration of a large thigh swelling which appeared after minor trauma. Imaging revealed a large well-encapsulated lesion with no vascularity. He was diagnosed to have a pseudotumor and underwent successful excision of the mass under blood and cryoprecipitate cover. The unusual presentation was suspected to be secondary to a transient drug-induced factor XIII deficiency because the result of the final coagulation study was normal.
Collapse
Affiliation(s)
- Indrani Sen
- Reprint requests: Indrani Sen, MS, Christian Medical College, Vellore 634002, Tamilnadu, India
| | | | | | | |
Collapse
|
30
|
Report of a patient with chronic intractable autoimmune hemorrhaphilia due to anti-factor XIII/13 antibodies who died of hemorrhage after sustained clinical remission for 3 years. Int J Hematol 2015; 101:598-602. [DOI: 10.1007/s12185-015-1754-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 01/22/2015] [Accepted: 01/26/2015] [Indexed: 10/24/2022]
|
31
|
Focosi D. Acquired factor XIII deficiency after desensitization as a potential contributor to postoperative bleeding: more than meets the eye. Transpl Int 2015; 28:246-7. [DOI: 10.1111/tri.12469] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Daniele Focosi
- Department of Translational Research; University of Pisa; Pisa Italy
| |
Collapse
|
32
|
Mumford AD, Ackroyd S, Alikhan R, Bowles L, Chowdary P, Grainger J, Mainwaring J, Mathias M, O'Connell N. Guideline for the diagnosis and management of the rare coagulation disorders: a United Kingdom Haemophilia Centre Doctors' Organization guideline on behalf of the British Committee for Standards in Haematology. Br J Haematol 2014; 167:304-26. [PMID: 25100430 DOI: 10.1111/bjh.13058] [Citation(s) in RCA: 208] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Andrew D Mumford
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
de Jager T, Pericleous L, Kokot-Kierepa M, Naderi M, Karimi M. The burden and management of FXIII deficiency. Haemophilia 2014; 20:733-40. [DOI: 10.1111/hae.12474] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2014] [Indexed: 11/27/2022]
Affiliation(s)
- T. de Jager
- Pharmerit International; AV Rotterdam the Netherlands
| | | | | | - M. Naderi
- Genetics of Non-Communicable Disease Research Center; Zahedan University of Medical Sciences; Zahedan Iran
| | - M. Karimi
- Haematology Research Centre; Shiraz University of Medical Sciences; Shiraz Iran
| |
Collapse
|
34
|
Cugno M, Gualtierotti R, Tedeschi A, Meroni PL. Autoantibodies to coagulation factors: From pathophysiology to diagnosis and therapy. Autoimmun Rev 2014; 13:40-8. [DOI: 10.1016/j.autrev.2013.08.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 08/06/2013] [Indexed: 12/20/2022]
|
35
|
W Collins P, Chalmers E, Hart D, Jennings I, Liesner R, Rangarajan S, Talks K, Williams M, R M Hay C. Diagnosis and management of acquired coagulation inhibitors: a guideline from UKHCDO. Br J Haematol 2013; 162:758-73. [PMID: 23889317 DOI: 10.1111/bjh.12463] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Peter W Collins
- School of Medicine, Cardiff University, University Hospital of Wales, Cardiff, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|