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Cai W, Shen J, Ma L. Hypoprothrombinemia-lupus anticoagulant syndrome secondary to Sjogren 's syndrome: A case report. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2023; 48:1775-1778. [PMID: 38432870 PMCID: PMC10929961 DOI: 10.11817/j.issn.1672-7347.2023.230186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Indexed: 03/05/2024]
Abstract
Hypoprothrombinemia-lupus anticoagulant syndrome (HLAS) is a rare disease in which patients present with varying degrees of bleeding and positive lupus anticoagulant with reduced prothrombin on laboratory tests. This article reports a case of HLAS in a middle-aged woman with recurrent gingival bleeding and epistaxis as the first presentation. After admission, tests revealed prolonged prothrombin time (PT), activated partial thromboplastin time (APTT), and reduced coagulation factor II activity, and positive lupus anticoagulant (LA). Meanwhile, the patient had symptoms of dry mouth and dry eyes for a long time, and the examination of autoantibodies, tear secretion test and salivary gland emission computed tomography (ECT) were consistent with the diagnosis of Sjogren's syndrome. The final diagnosis was HLAS secondary to Sjogren's syndrome. After treatment with methylprednisolone and cyclophosphamide, the coagulation disorder gradually improved, and no recurrent bleeding occurred. HLAS is a rare clinical case, which reminds medical staff to be alert to the possibility of HLAS when encountering patients with unexplained prolonged APTT and PT and positive lupus anticoagulant.
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Affiliation(s)
- Wei Cai
- Department of Hematology, First Affiliated Hospital of Dalian Medical University, Dalian Liaoning 116011, China.
| | - Jingzhi Shen
- Department of Hematology, First Affiliated Hospital of Dalian Medical University, Dalian Liaoning 116011, China.
| | - Liangliang Ma
- Department of Hematology, First Affiliated Hospital of Dalian Medical University, Dalian Liaoning 116011, China. ,
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2
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Sun YH, Nie WJ, Tian DD, Ye Q. Lupus anticoagulant- hypoprothrombinemia syndrome in children: Three case reports and systematic review of the literature. Lupus 2023; 32:1211-1221. [PMID: 37480550 DOI: 10.1177/09612033231191153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
OBJECTIVE Children with lupus anticoagulant hypoprothrombinemia syndrome (LAHPS) are characterized by prolonged activated partial thromboplastin time (APTT) and prothrombin time (PT), lupus anticoagulant positivity and low prothrombin (factor II, FII) levels. Bleeding or thrombosis tendencies related to LAHPS in children can occur due to the development of anti-prothrombin antibodies that are usually linked to autoimmune or infectious diseases. METHODS We report three pediatric cases of LAHPS and describe details on their clinical symptoms, laboratory characteristics, treatment. PubMed, Medline, and Web of Science searches were conducted on LAHPS in children between 1960 and 2023; articles in English were included. RESULTS The coagulation profile revealed prolonged PT and APTT, with low prothrombin levels (19.4%, 21.0% and 12.9%, respectively) and positive lupus anticoagulant in 3 pediatric cases. Fifty-nine relevant articles reported 93 pediatric LAHPS cases (mean age: 9 years (0.8-17 years)); 63 females and 30 males, 87 patients presented with minor to severe bleeding diathesis, and 3 patients presented with thrombosis events. Among 48 patients ≥9 years old, 36 had SLE; among 45 patients <9 years, 29 had viral infection. When all patients were divided into two groups based on age, associated disease, and factor II level, Pearson's χ2 tests were performed, p =.00, and there was clinical significance between autoimmune and infectious disease in patients ≥9 years old and <9 years old, and in patients FII level ≤10% and >10%. LAHPS patients with autoimmune disease had a protracted course and needed prolonged treatment with immune-modulating therapy, while those patients with infectious disease resolved spontaneously or needed short-term immune-modulating therapy. CONCLUSION LAHPS caused by autoimmune disease are common in patients ≥9 years old, especially SLE, and FII level ≤10% is often reported in patients caused by autoimmune disease, suggesting that children ≥9 years old diagnosed with LAHPS-related autoimmune disease should pay special attention to the FII level. While LAHPS caused by infectious disease is more frequently observed in patients <9 years, especially viral infection. Early diagnostic investigations are critical to differentiating LAHPS caused by autoimmune or infectious disease, as the prognosis, treatment and outcome are distinct.
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Affiliation(s)
- Yan-Hong Sun
- Department of clinical laboratory, National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wen-Jian Nie
- Department of clinical laboratory, National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dan-Dan Tian
- Department of clinical laboratory, National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qing Ye
- Department of clinical laboratory, National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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3
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Oka Y, Matsuda H, Miyazaki M. Severe hypoprothrombinemia caused by cefmetazole sodium in a patient undergoing hemodialysis: A case report. Ther Apher Dial 2022; 26:844-845. [PMID: 35293121 DOI: 10.1111/1744-9987.13837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/10/2022] [Accepted: 03/12/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Yoshinari Oka
- Department of Surgery, Saiwaicho Memorial Hospital, Okayama, Japan
| | - Hiroaki Matsuda
- Department of Surgery, Saiwaicho Memorial Hospital, Okayama, Japan
| | - Masashi Miyazaki
- Department of Surgery, Saiwaicho Memorial Hospital, Okayama, Japan
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Castillo Almeida NE, Stevens RW, Gurram P, Rivera CG, Suh GA. Cefazolin and rifampin: A coagulopathy-inducing combination. Am J Health Syst Pharm 2021; 78:2204-2208. [PMID: 34000006 DOI: 10.1093/ajhp/zxab210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To identify risk factors that may predispose patients to rifampin- and cefazolin-induced coagulopathy. SUMMARY An 86-year-old man with a history of rheumatoid arthritis on chronic prednisone and stage 3 chronic kidney disease, notably not on warfarin, presented to the hospital with a 10-day history of right hip pain, swelling, and drainage after a recent right total-hip arthroplasty. The patient underwent a combination of surgical intervention and medication therapy with rifampin and ceftriaxone. After discharge and at postoperative day 9, ceftriaxone was changed to cefazolin due to increasing alkaline phosphatase levels. Four weeks after the initial debridement, antibiotics, and implant retention, the patient underwent a second irrigation and debridement due to persistent infection. Cefazolin and rifampin therapy was extended. Three days later, the patient presented to the emergency room with significant bleeding at the surgical site and a profoundly elevated prothrombin time and international normalized ratio (INR). No potential contributors were identified. The Naranjo adverse drug reaction probability scale identified cefazolin and rifampin as the probable cause of elevated INR. The Liverpool adverse drug reaction avoidability assessment tool classified this adverse event as "definitely avoidable." CONCLUSION Rifampin-containing regimens are often recommended to treat staphylococcal prosthetic joint infections when the implant is retained. In methicillin-susceptible staphylococcal infections, cefazolin is routinely employed as the β-lactam backbone of definitive antimicrobial regimens. Although rifampin- and cefazolin-induced hypoprothrombinemia seems to be rare, adverse consequences of its occurrence may be prevented with appropriate monitoring.
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Affiliation(s)
| | | | - Pooja Gurram
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - Gina A Suh
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
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5
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Mansory EM, Bhai P, Stuart A, Laudenbach L, Sadikovic B, Lazo-Langner A. A case of congenital prothrombin deficiency with two concurrent mutations in the prothrombin gene. Res Pract Thromb Haemost 2021; 5:e12510. [PMID: 33977210 PMCID: PMC8105154 DOI: 10.1002/rth2.12510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/28/2021] [Accepted: 03/04/2021] [Indexed: 11/06/2022] Open
Abstract
Congenital prothrombin deficiency is an extremely rare, autosomal recessive bleeding disorder with a prevalence of 1 in 2 million individuals. Here, we report a case of congenital prothrombin deficiency with two concurrent mutations in the prothrombin gene (F2), affecting the heavy B chain. The patient presented with a history of multiple bleeding events in his youth that are mostly trauma associated, with a family history of prothrombin deficiency. Laboratory analysis showed a prolonged activated partial thromboplastin time and a prothrombin activity level of 5%. Genetic analysis of the F2 gene identified two heterozygous variants; one is a previously reported pathogenic deletion (c.1814_1815del; p.His605Argfs*13), and the other is a novel missense variant (c.1147C>T; p.Arg383Trp). In silico analysis predicted that p.Arg383Trp is likely to be disease causing, as it affects one of the anion-binding exosites-I of the B chain. This case highlights the significance of molecular findings in confirming the diagnosis of patients with congenital prothrombin deficiency.
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Affiliation(s)
- Eman M Mansory
- Division of Hematology Department of Medicine Western University London ON Canada.,Department of Hematology King Abdulaziz University Jeddah Saudi Arabia
| | - Pratibha Bhai
- Molecular Diagnostics Division Department of Pathology and Laboratory Medicine Western University London ON Canada
| | - Alan Stuart
- Molecular Diagnostics Division Department of Pathology and Laboratory Medicine Western University London ON Canada
| | - Lori Laudenbach
- Bleeding Disorders Program London Health Sciences Program London ON Canada
| | - Bekim Sadikovic
- Molecular Diagnostics Division Department of Pathology and Laboratory Medicine Western University London ON Canada
| | - Alejandro Lazo-Langner
- Division of Hematology Department of Medicine Western University London ON Canada.,Department of Epidemiology and Biostatistics Western University London ON Canada
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6
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Kocheril AP, Vettiyil GI, George AS, Shah S, Geevar T, Dave RG, T SK. Pediatric systemic lupus erythematosus with lupus anticoagulant hypoprothrombinemia syndrome-A case series with review of literature. Lupus 2021; 30:641-648. [PMID: 33509039 DOI: 10.1177/0961203321988934] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Lupus anticoagulant hypoprothrombinemia syndrome (LAHPS) is a rare phenomenon that leads to concomitant thrombosis and hemorrhage in children with SLE. LAHPS in pediatric SLE (pSLE) has a protracted course requiring long-term immunosuppressive therapy. Due to the rarity of this syndrome and paucity of reported cases, there is lack of standardized management. We herewith report 5 children with pSLE with LAHPS.Methodology: We retrospectively reviewed clinical features, laboratory features, treatment and outcome for 5 children with lupus anticoagulant hypoprothrombinemia syndrome with SLE and a review of literature of similar cases published. RESULTS Mean age of presentation was 10.2 ± 2.38 years (mean ± SD) and female to male ratio was 4:1. All children presented with mild to severe bleeding manifestations like gum bleed, epistaxis, hematuria, menorrhagia and subarachnoid bleed. Coagulation profile revealed prolonged PT and aPTT, with low prothrombin levels and positive Lupus anticoagulant in all children. Mixing studies were characteristic in these children. On comparing laboratory parameters majority had low C3, C4 levels, ANA and anti-DsDNA antibody positivity and three children had anticardiolipin positivity. One child had lupus nephritis along with LAHPS at presentation. All responded well to steroids and supportive measures. CONCLUSION High index of suspicion is needed when child with lupus presents with bleeding manifestations for early diagnosis and treatment.
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Affiliation(s)
- Anu Punnen Kocheril
- Pediatric Rheumatology, Department of Pediatrics, Christian Medical College, Vellore, India
| | - George Ipe Vettiyil
- Pediatric Rheumatology, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Anish Sam George
- Pediatric Rheumatology, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Sonam Shah
- Pediatric Rheumatology, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Tulasi Geevar
- Department of Transfusion Medicine and Immuno-Hematology, Christian Medical College, Vellore, India
| | - Rutvi Gautam Dave
- Department of Transfusion Medicine and Immuno-Hematology, Christian Medical College, Vellore, India
| | - Sathish Kumar T
- Pediatric Rheumatology, Department of Pediatrics, Christian Medical College, Vellore, India
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7
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Park GH, Kim S, Kim MS, Yu YM, Kim GH, Lee JS, Lee E. The Association Between Cephalosporin and Hypoprothrombinemia: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2019; 16:E3937. [PMID: 31623191 DOI: 10.3390/ijerph16203937] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 11/26/2022]
Abstract
Cephalosporins that contain the N-methylthiotetrazole side chain (NMTT-cephalosporin) have been reported to be associated with coagulation-related adverse events; however, a comprehensive evaluation regarding the association is lacking. A systematic review and meta-analysis were conducted to assess the safety profile of NMTT-cephalosporins with respect to hypoprothrombinemia and bleeding. The MEDLINE, Embase, Cochrane, and RISS databases were systematically searched for clinical studies up to October 2018. The association between NMTT-cephalosporins and hypoprothrombinemia was estimated using an odds ratio (OR) with a 95% confidence interval (CI). A total of 15 studies on cefamandole, cefoperazone, cefotetan, cefmetazole, and moxalactam were identified and included in the meta-analysis. Hypoprothrombinemia (OR 1.676, 95% CI 1.275–2.203) and prothrombin time (PT) prolongation (OR 2.050, 95% CI 1.398–3.005) were significantly associated with NMTT-cephalosporins, whereas bleeding was not (OR 1.359, 95% CI 0.920–2.009). Subgroup analyses revealed that cefoperazone (OR 2.506, 95% CI 1.293–4.860), cefamandole (OR 3.247, 95% CI 1.083–9.733), and moxalactam (OR 3.367, 95% CI 1.725–6.572) were significantly associated with hypoprothrombinemia. An Antimicrobial Stewardship Program led by a multidisciplinary team could play a critical role in monitoring cephalosporin-related hypoprothrombinemia or PT prolongation in patients with underlying clinical conditions at risk for bleeding. The multidisciplinary team could also assist in communicating the potential safety concerns regarding NMTT-cephalosporin use with healthcare professionals to decrease the risk of adverse events.
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8
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Gay E, Barthel A, Rouzic N, Henriot B, Quélennec B, Lorleac'h A, Prades N, Schmitt F. [Cefazolin and coagulation disorders: a case report]. Ann Biol Clin (Paris) 2018; 76:104-6. [PMID: 29231172 DOI: 10.1684/abc.2017.1314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report the case of a 79-year-old patient, admitted to the department of infectious diseases at Bretagne Sud Hospital Center for a right calcaneal osteitis, complicated by a pacemaker leads infectious endocarditis. Meticillin sensitive Staphylococcus aureus was documented by blood culture. Antibiotic treatment was established using intravenous cefazolin for an initial 6 weeks period. Prothrombin time (PT) decreased as well as vitamin K dependent factors, without anticoagulation therapy, at day 7 of cefazolin treatment. After bleeding occurred on calcaneal osteitis, the VAC® therapy system was removed and intravenous vitamin K 10 mg (then 5 mg per day for 5 days per os) was administered. Vitamin K allowed PT and vitamin K dependent factors to return to normal values. Literature review does not explicitly mention the effects on vitamin K dependent factors after cefazolin administration. Four severe haemorrhagic episodes under cefazolin have been declared in France so far since February 2017. The goal of this article is to alert clinicians and clinical pathologists from the potential appearance of coagulation disorders in patients treated by cefazolin.
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9
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Cetin Gedik K, Siddique S, Aguiar CL. Rituximab use in pediatric lupus anticoagulant hypoprothrombinemia syndrome - report of three cases and review of the literature. Lupus 2018; 27:1190-1197. [PMID: 29320972 DOI: 10.1177/0961203317751853] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lupus anticoagulant hypoprothrombinemia syndrome (LA-HPS) is a rare condition that may predispose both to thrombosis and bleeding due to positive lupus anticoagulant (LA) and factor II (FII) deficiency. It can be seen in association with infections or systemic lupus erythematosus (SLE) and may require glucocorticoids (GCs) and/or immunosuppressive medications. Pediatric LA-HPS cases in the literature and three cases that received only rituximab (RTX) for LA-HPS (in addition to GCs) at two institutions between January 2010 and June 2017 were analyzed descriptively. Pediatric LA-HPS cases (≤18 years) with bleeding or thrombotic events were included. Information obtained included demographics, presenting symptoms, diagnoses, treatments, pre-/post-treatment prothrombin time (PT)/partial thromboplastin time (PTT)/LA/FII levels, and outcomes. In addition to three LA-HPS cases identified at our institutions, as of June 2017, 37 articles reported 54 pediatric LA-HPS cases (mean age: 8 years (0.9-17 years); female/male: (2:1); viral illness 27 (50%), SLE 20 (37%), and other six (11%)). All cases had a positive LA and FII deficiency (range: 0%-40%). All cases presented with bleeding diathesis and were treated with various regimens, but there was no reported use of RTX. The purpose of this report is to describe the novel use of RTX as a steroid-sparing agent in three pediatric SLE cases and to systematically review the literature on pediatric cases of LA-HPS.
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Affiliation(s)
- K Cetin Gedik
- 1 Department of Pediatric Rheumatology, 25050 Steven and Alexandra Cohen Children's Medical Center , Lake Success, NY, USA
| | - S Siddique
- 2 Department of Pediatric Rheumatology, 25062 Hospital for Special Surgery -Weill Cornell Medical Center, New York, NY, USA
| | - C L Aguiar
- 3 Department of Pediatric Rheumatology, 20666 Children's Hospital of The King's Daughters , Norfolk, VA, USA
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10
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Kodama N, Matsumoto S, Matsubayashi S. A suspicious case of cefmetazole-induced hypoprothrombinemia. J Gen Fam Med 2017; 18:258-260. [PMID: 29264036 PMCID: PMC5689430 DOI: 10.1002/jgf2.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 04/04/2016] [Indexed: 11/18/2022] Open
Abstract
Cefmetazole occasionally prolongs the prothrombin time. The mechanism is considered to be because of (i) inhibition of vitamin K metabolism, (ii) a lack of vitamin K, and (iii) low vitamin K stores. We report the death of a 93-year-old woman who was administered cefmetazole and exhibited a prolonged prothrombin time. When using cefmetazole in elderly patients, PT-INR should be monitored every few days.
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Affiliation(s)
- Nobuhiro Kodama
- Department of General Internal MedicineFukuoka Tokushukai Medical CenterFukuokaJapan
| | - Shuichi Matsumoto
- Department of General Internal MedicineFukuoka Tokushukai Medical CenterFukuokaJapan
| | - Sunao Matsubayashi
- Department of Psychosomatic MedicineFukuoka Tokushukai Medical CenterFukuokaJapan
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11
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Foord A, Baca N, Buchbinder D, Mahajerin A. Lupus anticoagulant hypoprothrombinemia syndrome associated with severe thrombocytopenia in a child. Pediatr Blood Cancer 2017; 64. [PMID: 27862892 DOI: 10.1002/pbc.26357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/07/2016] [Accepted: 10/12/2016] [Indexed: 01/19/2023]
Abstract
Lupus anticoagulant hypoprothrombinemia syndrome (LAHPS) comprises lupus anticoagulant, acquired hypoprothrombinemia, and often mild thrombocytopenia or normal platelets. It is usually associated with autoimmunity or postviral illness. We describe a case of a 10-year-old boy with oral bleeding and severe thrombocytopenia initially suggestive of immune thrombocytopenia. Secondary to bleeding, evaluation demonstrated prolonged coagulation tests and subsequently revealed the presence of lupus anticoagulant and hypoprothrombinemia, along with marked autoimmunity, suggestive of LAHPS. He was treated with intravenous immunoglobulin and hydroxychloroquine. This case report and discussion highlight the diagnostic and therapeutic challenges associated with LAHPS and coincident severe thrombocytopenia.
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Affiliation(s)
- Aimee Foord
- Hematology-Oncology Hospitalist Service, Division of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Nicole Baca
- Division of Hematology/Oncology, CHOC Children's Hospital, Orange, California
| | - David Buchbinder
- Division of Hematology/Bone Marrow Transplant, CHOC Children's Hospital, Orange, California
| | - Arash Mahajerin
- Division of Hematology, CHOC Children's Hospital, Orange, California
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12
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Sarker T, Roy S, Hollon W, Rajpurkar M. Lupus anticoagulant acquired hypoprothrombinemia syndrome in childhood: two distinct patterns and review of the literature. Haemophilia 2015; 21:754-60. [PMID: 25929557 DOI: 10.1111/hae.12669] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Lupus anticoagulant associated with acquired prothrombin deficiency also known as 'lupus anticoagulant hypoprothrombinemia syndrome' (LAHS) is an entity that is well described in adults and is usually associated with autoimmune conditions (LAHS-AI). However, in children, LAHS has unique features that are distinct from the adult type. AIMS We report two paediatric cases of LAHS, describe their distinct patterns and review the paediatric literature on LAHS. METHODS Case studies on two patients with LAHS were reviewed, details on their presentation, work up and management were extracted. A Medline search was conducted on LAHS in children between 1960 and 2014; Articles in languages other than English were excluded. RESULTS The case studies highlight the differences in the two patterns of childhood LAHS. Additionally the review of the literature reveals that there are 15 case reports and 5 case series that report 25 children with LAHS-AI, 9 case reports and 6 case series report 26 children of LAHS associated with viral infections (LAHS-VI). At presentation, all patients with LAHS-AI had positive laboratory tests for autoimmune diseases, most commonly for systemic lupus erythematosus while these tests were negative in LAHS-VI. All patients with LAHS-AI had a protracted course and needed prolonged treatment with immune-suppressive therapy while patients with LAHS-VI resolved spontaneously or needed short-term immune-modulating therapy. CONCLUSION In childhood, two distinct patterns of LAHS are observed, either associated with infection or autoimmune disease. Initial diagnostic investigations are critical to differentiating these two patterns as the prognosis and outcome for each is distinct.
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Affiliation(s)
- T Sarker
- Division of Hematology/Oncology, Carman and Ann Adams, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA.,Wayne State University, Detroit, MI, USA
| | - S Roy
- Division of Hematology/Oncology, Carman and Ann Adams, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA.,Wayne State University, Detroit, MI, USA
| | - W Hollon
- Wayne State University, Detroit, MI, USA
| | - M Rajpurkar
- Division of Hematology/Oncology, Carman and Ann Adams, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA.,Wayne State University, Detroit, MI, USA
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13
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Mulliez SMN, De Keyser F, Verbist C, Vantilborgh A, Wijns W, Beukinga I, Devreese KMJ. Lupus anticoagulant- hypoprothrombinemia syndrome: report of two cases and review of the literature. Lupus 2014; 24:736-45. [PMID: 25391540 DOI: 10.1177/0961203314558859] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 10/10/2014] [Indexed: 11/16/2022]
Abstract
Lupus anticoagulant-hypoprothrombinemia syndrome (LA-HPS) is a rare acquired disorder caused by prothrombin antibodies. The disease is most common in the pediatric age group (<16 years), and more prevalent in women. There are well-established clinical diseases associated with LA-HPS, most notably systemic lupus erythematosus (SLE) and viral infections. The clinical manifestation of LA-HPS varies greatly in severity and it may cause severe life-threatening bleeding diathesis. LA-HPS is to be suspected when a patient presents with bleeding and a prolonged activated partial thromboplastin and prothrombin time, in combination with a lupus anticoagulant. The diagnosis is confirmed in the laboratory by identification of reduced prothrombin levels. There are no standardized recommendations for treatment of the hemorrhage associated with the syndrome; corticosteroids are used as first-line treatment. This review summarizes what is currently known about the pathogenesis, clinical features, diagnosis, treatment and prognosis of LA-HPS, and presents two case reports.
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Affiliation(s)
- S M N Mulliez
- Coagulation Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital, Ghent, Belgium
| | - F De Keyser
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - C Verbist
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - A Vantilborgh
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
| | - W Wijns
- Department of Hematobiology, Erasme Hospital, Brussels, Belgium
| | - I Beukinga
- Department of Hematobiology, Erasme Hospital, Brussels, Belgium
| | - K M J Devreese
- Coagulation Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital, Ghent, Belgium
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Abstract
OBJECTIVE To report the case of a patient who presented with rare necrotizing esophagitis related to cefazolin-associated coagulopathy. A review of the literature is also provided. CASE SUMMARY A 53-year-old male patient was admitted for management of septicemia and femur osteomyelitis. Long-term cefazolin treatment was initiated after cultures and sensitivity revealed methicillin-sensitive Staphylococcus aureus. The patient was given intravenous cefazolin 2 g every 24 hours. On day 15 of cefazolin treatment, the patient presented to the emergency department complaining of black coffee ground emesis. On upper-gastrointestinal endoscopy, the patient was determined to have necrotizing esophagitis. He was found to have an international normalized ratio (INR) of 8.11 and prothrombin time (PT) of 89.2 s. Intravenous vitamin K, fresh frozen plasma, and packed red blood cells were administered. The INR was rechecked 4 hours later and found to have decreased to 1.55 with a PT of 17 s. The patient did not have medical conditions or take medications that could have caused bleeding. DISCUSSION Based on the Naranjo algorithm, it was determined that cefazolin had a "probable" relationship. Increased bleeding risk has been associated with other cephalosporins, although much less commonly with cefazolin. Possible mechanisms and implications are discussed. CONCLUSIONS High-risk patients being treated with cefazolin therapy should be monitored for potentially severe adverse events, including bleeding and necrotizing esophagitis.
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Affiliation(s)
| | - Shiqing Yan
- Indiana University Arnett Hospital, Lafayette, IN, USA
| | - Yaman Kaakeh
- Purdue University, West Lafayette, IN, USA Indiana University Arnett Hospital, Lafayette, IN, USA
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Abstract
The presence of lupus anticoagulant is associated with an elevated risk of venous and arterial thrombosis, and recurrent miscarriages as well. For some cases, this disease can present with bleeding as a consequence of lupus anticoagulant hypoprothrombinemia (LAHPS). LAHPS is a rare disease and it is reported to be most frequent in young females with/without systemic lupus erythematosus or in healthy children who are suffering with a viral infection. In such cases, steroid therapy is usually effective in normalizing the biological abnormalities and controlling the bleeding problems. A 34-year-old previously healthy man was admitted to our department because of his prolonged coagulation times; these abnormalities were discovered before performing orthopedic surgery. The prothrombin time (PT) was 15.2 sec, and the activated partial thromboplastin time (APTT) was 37.7 sec. A 1:1 dilution of patient plasma with normal plasma nearly corrected the PT, but this failed to correct the APTT. Evaluation of the clotting factors revealed decreased levels of factors II, V, VIII, IX and XI. The presence of LA was demonstrated by the dRVVT test, and the patient was diagnosed with LAHPS. He was successfully treated with corticosteroid before performing the orthopedic surgery.
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Affiliation(s)
- Choon Hae Chung
- Department of Internal Medicine, College of Medicine Chosun University, Gwangju, Korea
| | - Chi Young Park
- Department of Internal Medicine, College of Medicine Chosun University, Gwangju, Korea
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