[Successful long-term management of ovarian bleeding and menorrhagia with prothrombin complex concentrate in a patient with congenital factor X deficiency]

A female patient in her forties exhibited no evidence of abnormal bleeding at birth. At the age of 6 years, she experienced pain in bilateral thighs and knee joints without any occasion. Accordingly, the bleeding tendency was suspected, and the coagulation profile assessment revealed prolongation of the APTT (122 s). Further tests revealed a marked reduction in the factor X activity (FX:C) to 4.5%, and the patient was diagnosed with congenital factor X deficiency; at that time, the case was reported by Mori et al. (The Japanese Society of Hematology 43: 572-586, 1980). At the age of 19 years, she was transferred to our hospital, where both prolongation of the PT and APTT and reduction of FX:C to <1% were reconfirmed. During follow-up observation, the patient developed lower abdominal pain and severe anemia. Gynecological examination revealed ovarian bleeding with menorrhagia. Thus, she was prescribed low-dose pills for menorrhagia, which successfully arrested the progression of anemia for a long term. However, she underwent uterine myomectomy and developed anemia again because of menorrhagia. For controlling menorrhagia-caused severe anemia, we initiated the patient on FX replacement therapy with prothrombin complex concentrate, PPSB-HT "Nichiyaku," by self-infusion on day 1 of each monthly menstrual cycle. Since then, menorrhagia and severe anemia have remained under good control.