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He J, Zhou W, Lv H, Tao L, Chen X, Wang L. Novel IVS7+1G>T mutation of life-threatening congenital factor VII deficiency in neonates: A retrospective study in China. Medicine (Baltimore) 2019; 98:e17360. [PMID: 31577732 PMCID: PMC6783214 DOI: 10.1097/md.0000000000017360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
In neonates, congenital factor VII deficiency (FVIID) is characterized by central nervous system bleeding and gastrointestinal hemorrhage, often resulting in poor prognosis and high mortality.To improve understanding of FVIID in neonates in Asia, we retrospectively analyzed the clinical manifestations, diagnosis, treatment, clinical course, and genetic diagnosis of 2 cases of neonatal FVIID in the Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou, China, from January 2007 to December 2017 and performed a review of the relevant literature.Both neonates were female and presented with severe gastrointestinal tract and intracranial hemorrhage. The laboratory findings were characterized by repeated and non-vitamin K1-dependent prolonged of the prothrombin time (PT), Factor VII (FVII) activity was 1.5% and 3%, respectively. Both neonates died of severe intracranial hemorrhage, at 31 days and 6 months after birth, respectively. Gene sequencing results revealed a homozygous mutation in the FVII gene splice site (IVS7+1G>T) in both cases. Upon review of relevant literature published since 1996, we identified 19 cases of neonatal FVIID. The patients were full-term neonates with onset of symptoms mostly within 7 days after birth (73.7%), which included gastrointestinal bleeding (blood stool, vomiting blood; 31.6%), nervous system signs (drowsiness, convulsions, poor response; 26.3%), severe intracranial hemorrhage (84.2%), significantly prolonged PT with significantly decreased FVII activity (89.5%), high mortality, and disability (68.4%). Gene sequencing was performed in 9 of the 19 children evaluated and revealed a mutation in the FVII gene in all cases.FVIID can be clinically diagnosed based on the presence of prolonged PT that is difficult to correct and significantly decreased FVII activity (≤5%). As mutations in some sites are associated with severe bleeding, genetic diagnosis represents a useful tool for prenatal diagnosis of FVIID. In brief, we should pay great attention to the FVIID onset of the neonatal period, although it is rare but result in life-threatening bleeding with poor prognosis.
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Affiliation(s)
- Juan He
- The First Affiliated Hospital of Jinan University
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangdong, China
| | - Wei Zhou
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangdong, China
| | - Hui Lv
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangdong, China
| | - Li Tao
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangdong, China
| | - XiaoWen Chen
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangdong, China
| | - Ling Wang
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangdong, China
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Shah NM, Chong SE, Yusoff SM, Mazlan MZ, Johan KB, Azman N, Lim JA, Mohamad SM, Noordin SS, Ghaffar ZA, Hassan MH, Zabidi MA, Rahim NAA. Recombinant activated factor VII (rFVIIa) in refractory haemorrhage for non-haemophiliacs: an eleven-year single-centre experience. BMC HEMATOLOGY 2018; 18:34. [PMID: 30498571 PMCID: PMC6251212 DOI: 10.1186/s12878-018-0126-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/17/2018] [Indexed: 11/12/2022]
Abstract
Background Massive bleeding is one of the commonest salvageable causes of death. The search for an ideal haemostatic agent during massive bleeding is still ongoing. One of the novel haemostatic medications is recombinant activated factor VII (rFVIIa). To date, the usage of rFVIIa during massive haemorrhage among non-haemophiliac patients remains off-label. The aim of this study is to report our experience in using rFVIIa to treat refractory bleeding. Methods Medical records of all patients treated with rFVIIa for massive bleeding over an eleven-year period in a single institution were recorded. Treatment indications, 24-h and 30-day mortality, changes in transfusion needs and coagulation profiles after rFVIIa administration were analysed. Results rFVIIa were administered in 76 patients. Of these, 41 (53.9%) were non-surgical bleeding, followed by 22 patients (28.9%) with trauma, other surgery bleedings in 9 patients (11.8%) and 4 patients (5.4%) with peripartum haemorrhage. Total survival rate was 78.9% within 24 h and 44.7% over 30 days. Among all these patients who had received rFVIIa due to life-threatening haemorrhage, blood and blood product requirements were significantly reduced (P < 0.001), and the coagulation profiles improved significantly (P < 0.05). Two patients with preexisting thromboembolism were given rFVIIa due to intractable bleeding, both survived. No thromboembolic events were reported after the administration of rFVIIa. Conclusions rFVIIa significantly improved coagulation parameters and reduced blood product requirements during refractory haemorrhage. Additionally, usage of rFVIIa in trauma and peripartum haemorrhage patients yield better outcomes than other groups of patients. However, the overall mortality rate remained high.
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Affiliation(s)
- Nurfatin Mohd Shah
- 1Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200 Kepala Batas, PNG Malaysia
| | - Soon Eu Chong
- 1Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200 Kepala Batas, PNG Malaysia.,3Hospital Universiti Sains Malaysia, 16150 Kubang Kerian, KTN Malaysia
| | - Syahirah Mohamed Yusoff
- 1Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200 Kepala Batas, PNG Malaysia
| | - Mohd Zulfakar Mazlan
- 2School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, KTN Malaysia.,3Hospital Universiti Sains Malaysia, 16150 Kubang Kerian, KTN Malaysia
| | - Khairul Bariah Johan
- 3Hospital Universiti Sains Malaysia, 16150 Kubang Kerian, KTN Malaysia.,5Department of Pharmacy, Hospital Universiti Sains Malaysia, 16150 Kubang Kerian, KTN Malaysia
| | - Nizuwan Azman
- 1Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200 Kepala Batas, PNG Malaysia
| | - Jo Anne Lim
- 4Department of Internal Medicine, Hospital Sultan Abdul Halim, 08000 Sungai Petani, KDH Malaysia
| | - Siti Mardhiana Mohamad
- 1Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200 Kepala Batas, PNG Malaysia
| | - Siti Salmah Noordin
- 1Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200 Kepala Batas, PNG Malaysia
| | - Zainab Abdul Ghaffar
- 6Integrative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200 Kepala Batas, PNG Malaysia
| | - Mohd Hasyizan Hassan
- 2School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, KTN Malaysia.,3Hospital Universiti Sains Malaysia, 16150 Kubang Kerian, KTN Malaysia
| | - Muhammad Azrul Zabidi
- 1Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200 Kepala Batas, PNG Malaysia
| | - Nur Arzuar Abdul Rahim
- 1Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200 Kepala Batas, PNG Malaysia
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