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Katsuren E, Kohagura K, Kinjyo T, Zamami R, Nakamura T, Oshiro N, Sunagawa Y, Omine K, Kudo Y, Shinzato Y, Osaki T, Souri M, Ichinose A, Yamazato M, Ishida A, Ohya Y. Acquired factor V inhibitor with erythema and eosinophilia in a patient with end-stage renal disease. CEN Case Rep 2023; 12:91-97. [PMID: 35943699 PMCID: PMC9361254 DOI: 10.1007/s13730-022-00725-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/24/2022] [Indexed: 02/04/2023] Open
Abstract
Autoimmune factor V deficiency (AiFVD) is a rare bleeding disorder caused by factor V inhibitors. In this report, we present the case of an 89-year-old man who developed bleeding tendency during surgery to create arteriovenous fistula for hemodialysis. The bleeding tendency developed with prolongation of activated partial thromboplastin and prothrombin time, following drug-induced eruption and eosinophilia. Significant reduction in coagulation factor activity and inhibitory pattern in cross-mixing tests suggested the presence of inhibitors to coagulation factors. Subsequently, we detected a factor V inhibitor and anti-factor V autoantibodies was confirmed using enzyme-linked immunosorbent assay with purified human plasma factor V. Thus, the patient was 'definitely diagnosed' with AiFVD in accordance with the diagnostic criteria enacted by the Japanese Ministry of Health, Labor, and Welfare. The bleeding tendency improved after initiating oral prednisolone 50 mg (1 mg/kg) followed by normalization of activated partial thromboplastin time and prothrombin time at the 34th day. After improving the coagulation system prolongation, the inhibitor and autoantibodies has been eradicated. Since it is suggested that drug-induced immune response can cause AiFVD, AiFVD should be considered in patients who undergo hemodialysis and develop failure of hemostasis and drug-induced eruption.
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Affiliation(s)
- Eisuke Katsuren
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kentaro Kohagura
- Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan.
| | - Takanori Kinjyo
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Ryo Zamami
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
- Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan
| | - Takuto Nakamura
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
- Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan
| | - Nanako Oshiro
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yoshitsugu Sunagawa
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kumiko Omine
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yuki Kudo
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yuki Shinzato
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tsukasa Osaki
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata, 990-9585, Japan
- The Japanese Collaborative Research Group (JCRG) On Autoimmune Acquired Coagulation Factor Deficiencies Supported By the Japanese Ministry of Health, Labor and Welfare (MHLW), Tokyo, Japan
- Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science, 2-2-2, Iida-Nishi, Yamagata, 990-9585, Japan
| | - Masayoshi Souri
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata, 990-9585, Japan
- The Japanese Collaborative Research Group (JCRG) On Autoimmune Acquired Coagulation Factor Deficiencies Supported By the Japanese Ministry of Health, Labor and Welfare (MHLW), Tokyo, Japan
- Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science, 2-2-2, Iida-Nishi, Yamagata, 990-9585, Japan
| | - Akitada Ichinose
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata, 990-9585, Japan
- The Japanese Collaborative Research Group (JCRG) On Autoimmune Acquired Coagulation Factor Deficiencies Supported By the Japanese Ministry of Health, Labor and Welfare (MHLW), Tokyo, Japan
| | - Masanobu Yamazato
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Akio Ishida
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yusuke Ohya
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Sei M, Mizuguchi M, Yagi H, Kagawa K, Sekimoto E, Shibata H, Shigekiyo T, Ozaki S. [Clinical features of five cases of acquired factor V deficiency]. Rinsho Ketsueki 2022; 63:733-739. [PMID: 35922940 DOI: 10.11406/rinketsu.63.733] [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] [Indexed: 06/15/2023]
Abstract
Acquired factor V deficiency is a rare disease that presents with various bleeding symptoms because of the acquired production of factor V inhibitors and decrease in factor V activity. We have experienced five cases of acquired factor V deficiency diagnosed on the basis of abnormalities in coagulation tests in the last 10 years. All five patients were older men, of whom one had no bleeding symptoms, and three had a history of renal failure and malignant tumors. In the cross-mixing test, two of three cases demonstrated an inhibitor pattern, but one case showed a deficient pattern. In all cases, steroid treatment improved factor V activity as well as prothrombin time and activated partial thromboplastin time. However, patients with intracranial hemorrhage had a poor prognosis. Although this disease is rare, careful management is necessary, especially in the absence of bleeding symptoms and where cross-mixing test does not show an inhibitor pattern.
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Affiliation(s)
- Motoko Sei
- Medical Education Center, Tokushima Prefectural Central Hospital
| | - Makiko Mizuguchi
- Department of Hematology, Tokushima Prefectural Central Hospital
| | - Hikaru Yagi
- Department of Hematology, Tokushima Prefectural Central Hospital
| | - Kumiko Kagawa
- Department of Hematology, Tokushima Prefectural Central Hospital
| | - Etsuko Sekimoto
- Department of Hematology, Tokushima Prefectural Central Hospital
- Department of Internal Medicine, Tenma Hospital
| | - Hironobu Shibata
- Department of Hematology, Tokushima Prefectural Central Hospital
| | - Toshio Shigekiyo
- Department of Hematology, Tokushima Prefectural Central Hospital
| | - Shuji Ozaki
- Department of Hematology, Tokushima Prefectural Central Hospital
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Dong R, Chen G, Jin Y, Wang M, Cheng X, Chen Y. Significance of the p.Phe218Ser and p.Gly304Glu F5 Variants in Hereditary Factor V Deficiency. Acta Haematol 2021; 144:712-716. [PMID: 34280927 DOI: 10.1159/000512363] [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] [Received: 01/14/2020] [Accepted: 10/17/2020] [Indexed: 11/19/2022]
Abstract
Hereditary factor V (FV) deficiency is a rare autosomal recessive bleeding disorder caused by F5 gene mutations. The objective of this study was to investigate the p.Phe218Ser and p.Gly304Glu variants found in 2 families with hereditary FV deficiency. The FV activity (FV:C) and FV antigen (FV:Ag) were measured by clotting and ELISA, respectively. The F5 gene and sequence conservation were analyzed by direct sequencing and ClustalX-2.1-win, respectively. One proband carried a homozygous p.Phe218Ser (c.653T>C) mutation, with FV:C and FV:Ag decreased to 11 and 14%, respectively. The other proband carried a heterozygous p.Gly304Glu (c.911G>A) mutation, with FV:C and FV:Ag reduced to 55 and 62%, respectively. Phe218 and Gly304 were highly conserved in the homologous gene in 9 other species. We hypothesized that the p.Phe218Ser and p.Gly304Glu variants are deleterious and responsible for the reduction in FV:C and FV:Ag.
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Affiliation(s)
- Rujiao Dong
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guoliang Chen
- Department of Spine Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yanhui Jin
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mingshan Wang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoli Cheng
- Department of Clinical Laboratory, The First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Yi Chen
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Yanagiya R, Kanouchi K, Toubai T, Yamada A, Aizawa K, Shiono Y, Ito S, Ishizawa K. Plasma Exchange as an Initial Treatment for Severe Bleeding Induced by Acquired Factor V Deficiency: A Case Report and Mini Literature Review. Acta Haematol 2020; 144:82-87. [PMID: 32784304 DOI: 10.1159/000505770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 12/22/2022]
Abstract
Acquired factor V deficiency (AFVD) is a rare autoimmune bleeding disorder. Unlike acquired hemophilia, bypass therapies with recombinant activated factor VII and activated prothrombin complex concentrates are ineffective for severe bleeding due to AFVD. Although several treatment strategies have been attempted, a standard of care for severe hemorrhage induced by AFVD is lacking. Herein, we report a case of AFVD with severe bleeding that responded to plasma exchange (PE) combined with immunosuppression. We also reviewed previously reported AFVD cases with severe hemorrhage and suggest that PE may be an effective initial treatment for AFVD-induced severe hemorrhage.
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Affiliation(s)
- Ryo Yanagiya
- Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology (Third Internal Medicine), Yamagata University, Yamagata, Japan
| | - Kazunori Kanouchi
- Department of Clinical Laboratory, Yamagata University Hospital, Yamagata, Japan
| | - Tomomi Toubai
- Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology (Third Internal Medicine), Yamagata University, Yamagata, Japan
| | - Akane Yamada
- Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology (Third Internal Medicine), Yamagata University, Yamagata, Japan
| | - Keiko Aizawa
- Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology (Third Internal Medicine), Yamagata University, Yamagata, Japan
| | - Yosuke Shiono
- Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology (Third Internal Medicine), Yamagata University, Yamagata, Japan
| | - Satoshi Ito
- Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology (Third Internal Medicine), Yamagata University, Yamagata, Japan
| | - Kenichi Ishizawa
- Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology (Third Internal Medicine), Yamagata University, Yamagata, Japan,
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5
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Abstract
BACKGROUND Acquired factor V deficiency (AFVD) caused by Factor V (FV) inhibition is a rare event, characterized by prolonged prothrombin time and activated partial thromboplastin time. To date, various factors were reported as triggers for developing FV inhibitor. Clinical symptoms range from asymptomatic to life-threatening bleeding. Case Report and Conclusions: Here, we report an 84-year-old Japanese male on hemodialysis due to renal failure who developed subcutaneous hemorrhage after administration of cefepime (CFPM) to treat bacteremia. Deficient FV activity (< 1.0%) was identified and AFVD with FV inhibitor titer of 9 BU/mL was diagnosed. Although the patient had multiple risks for developing FV inhibitor, CFPM was thought to be the major culprit in this case. After the diagnosis, oral prednisolone (30 mg/day) was initiated, but the patient died of respiratory/cardiac failure, unrelated to AFVD.
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Abstract
RATIONALE Acquired inhibitors of coagulation are antibodies that either inhibit the activity or increase the clearance of a clotting factor. Acquired factor V deficiency is a rare coagulation disorder, and it can sometimes be life threatening. PATIENT CONCERNS We describe a case of a 90-year-old Japanese male with acquired factor V deficiency. He was previously misdiagnosed with congenital factor V deficiency when he presented with hemoptysis and a negative factor V inhibitor test result at a different hospital 5 years earlier. Coagulopathy recurred with ecchymosis when he sustained a bruise after falling on a bush. DIAGNOSIS Although the factor V inhibitor test result was negative and a mixing study suggested a deficiency pattern, we diagnosed the patient with acquired factor V deficiency on the basis of no history of bleeding diathesis, a lack of response to multiple fresh frozen plasma transfusion, and clinical response to corticosteroid therapy. INTERVENTIONS Intravenous methylprednisolone was administered at 500 mg/day for 3 days, followed by oral prednisolone at 1 mg/kg/day. OUTCOMES Coagulation test results improved and symptoms resolved 2 weeks after corticosteroid administration. LESSONS This case report suggests that clearance-facilitating antibodies exist without the presence of neutralizing inhibitors. When patients present with coagulation factor V deficiency in the absence of coagulation inhibitors, acquired factor V deficiency should also be considered.
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Affiliation(s)
- Kiyoshi Takemoto
- Department of General Internal Medicine, Nara City Hospital, Nara
- Department of General Internal Medicine, Nerima Hikarigaoka Hospital, Tokyo
| | - Osamu Hamada
- Department of General Internal Medicine, Nerima Hikarigaoka Hospital, Tokyo
| | - Koichi Kitamura
- Department of General Internal Medicine, Nerima Hikarigaoka Hospital, Tokyo
- Department of Nephrology, Endocrinology, and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba
| | - Naoki Fujiwara
- Department of General Internal Medicine, Nerima Hikarigaoka Hospital, Tokyo
| | - Yoshitaka Miyakawa
- Department of General Internal Medicine, Nerima Hikarigaoka Hospital, Tokyo
- Department of General Internal Medicine, Thrombosis and Hemostasis Center, Saitama Medical University Hospital, Saitama, Japan
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Kadohira Y, Yamada S, Hayashi T, Morishita E, Asakura H, Ichinose A. A discrepancy between prothrombin time and Normotest (Hepaplastintest) results is useful for diagnosis of acquired factor V inhibitors. Int J Hematol 2018; 108:145-150. [PMID: 29611057 DOI: 10.1007/s12185-018-2453-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Received: 01/18/2018] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 11/27/2022]
Abstract
Acquired coagulation factor inhibitors are rare. Among them, coagulation factor V (FV) inhibitor is particularly uncommon and presents with variable clinical manifestations. Certain acquired FV inhibitor patients have only mild bleeding or, in select cases, no symptoms at all, leading to spontaneous recovery. Others have life-threatening bleeding that requires medical attention. Thus, a prompt decision regarding diagnosis and clinical intervention is crucial for such patients. In five acquired FV inhibitor cases treated in our facility, each patient had a malignancy as an underlying disease and all unexpectedly showed prolongation of both prothrombin time (PT) and activated partial thromboplastin time (APTT). They all also displayed a discrepancy between PT and Normotest (Hepaplastintest, HPT) results. All but one patient experienced no bleeding at the time of diagnosis and achieved spontaneous recovery in 1-3 weeks. The patient with bleeding symptoms received plasma exchanges and a platelet transfusion. Useful markers in diagnosing the presence of an acquired FV inhibitor were a sudden prolongation of PT and APTT, and a discrepancy between the PT/APTT and HPT assays. Spontaneous recovery can be expected for patients with only minor bleeding.
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Affiliation(s)
- Yasuko Kadohira
- Department of Hematology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Shinya Yamada
- Department of Hematology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tomoe Hayashi
- Department of Hematology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Eriko Morishita
- Department of Hematology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hidesaku Asakura
- Department of Hematology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
- Japanese Collaborative Research Group on Autoimmune Haemorrhaphilia Supported by the Japanese Ministry of Health, Labor and Welfare, Yamagata, Japan
| | - Akitada Ichinose
- Japanese Collaborative Research Group on Autoimmune Haemorrhaphilia Supported by the Japanese Ministry of Health, Labor and Welfare, Yamagata, Japan
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School, Yamagata, Japan
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Maeda K, Kaji T, Nakayama S, Nakaoku D, Murakami M, Kondo A, Morine M, Hinokio K, Irahara M. Pregnancies with factor V deficiency: a case report and review of the literature. CLIN EXP OBSTET GYN 2017; 44:299-300. [PMID: 29746045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
CASE REPORT A 30-year-old Japanese nulliparous woman visited for pregnancy at 33 weeks with a massive ovarian tumor located in the pouch of Douglas. By preoperative screening, her prothrombin time (PT) and activated partial thromboplastin time (APTT) were prolonged, and her FV activity was significantly decreased to 4.8%. After prophylactic FFP 20 ml/kg was administered and her FV factor was 19.3%, cesarean delivery was performed, and her perioperative course was uneventful. One year later, she underwent a dilatation and evacuation because of a missed abortion, although prophylactic FFP was not administered. During a third pregnancy, after prophylactic FFP 20 ml/kg was administered and FV activity increased to 21.1%, elective cesarean delivery was performed, and her postoperative course was uneventful. CONCLUSION For surgical therapy or delivery, the goal of therapy is to maintain FV activity above 20%. It is particularly useful to administer prophylactic FFP.
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Kvezereli-Kopadze M, Kvezereli-Kopadze A, Chikovani M. [CONGENITAL DEFICIENCY OF COAGULATION FACTOR V]. Georgian Med News 2016:58-61. [PMID: 27661277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The study was designed to investigate the 5 year old girl with rare bleeding disorder -deficiency of coagulation factor V. The diagnosis was based on detail family history, physical examination and para-clinical data analyses. The age of patient, purpura, this has been detected from early age, positive family history, non-controlled, longtime bleeding, inadequate trauma of the tongue, which did not resolve after surgery, strong hypocoagulation, which was slightly improved, after several plasma transfusions. This allowed us to suggest the existence of the congenital coagulopathy, which was confirmed by the investigation of coagulation factors - particularly the deficiency of factor V was detected.
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Affiliation(s)
- M Kvezereli-Kopadze
- Tbilisi State Medical University, G. Zhvania Pediatric Academic Clinic, Tbilisi, Georgia
| | - A Kvezereli-Kopadze
- Tbilisi State Medical University, G. Zhvania Pediatric Academic Clinic, Tbilisi, Georgia
| | - M Chikovani
- Tbilisi State Medical University, G. Zhvania Pediatric Academic Clinic, Tbilisi, Georgia
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Mansouritorghabeh H, Shirdel A. Desmopressin acetate as a haemostatic elevator in individuals with combined deficiency of factors V and VIII: a clinical trial. J Thromb Haemost 2016; 14:336-9. [PMID: 26599105 DOI: 10.1111/jth.13207] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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] [Received: 08/08/2015] [Accepted: 10/25/2015] [Indexed: 11/30/2022]
Abstract
UNLABELLED ESSENTIALS: Combined factor V (FV) and factor VIII (FVIII) deficiency (CF5F8D) is an autosomal recessive coagulation disorder. Desmopressin acetate (DDAVP) was intravenously infused in 20 adult patients with CF5F8D. DDAVP can enhance FVIII levels but has no effect on FV levels in patients with CF5F8D. DDAVP can be substituted for FVIII concentrates in patients with CF5F8D. OBJECTIVES Combined factor V (FV) and FVIII deficiency (CF5F8D) is a rare inherited autosomal recessive double-gene disorder most frequently seen in the Middle East. Although affected individuals have deficiency of two coagulation factors (range 5-30%), their bleeding tendencies are similar to patients who have deficiency of a single coagulation factor at the same level. The mainstay of their treatment is infusion of FVIII concentrate and fresh frozen plasma. Here, the effect of intravenous infusion of desmopressin acetate (DDAVP) on elevation of coagulation FV and FVIII was investigated through a clinical trial in May 2015. PATIENTS AND METHODS In a registered controlled trial, DDAVP (dosage 0.3 μg kg(-1) ) was intravenously infused into 20 adult patients with CF5F8D over 20 min. After an hour, blood samples were collected and plasma levels of FV and FVIII were measured. RESULTS AND CONCLUSION This study revealed that DDAVP can enhance FVIII levels but has no effect on FV plasma concentration in patients with CF5F8D. Based on these findings, FVIII concentrates may be substituted for DDAVP in patients with CF5F8D.
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Affiliation(s)
- H Mansouritorghabeh
- Allergy Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - A Shirdel
- Internal Medicine Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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11
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Donohoe K, Levine R. Acquired factor V inhibitor after exposure to topical human thrombin related to an otorhinolaryngological procedure. J Thromb Haemost 2015; 13:1787-9. [PMID: 26270511 DOI: 10.1111/jth.13114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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] [Received: 04/10/2015] [Accepted: 08/02/2015] [Indexed: 11/27/2022]
Abstract
Acquired factor V (FV) inhibitors occur rarely and classically develop after exposure to bovine thrombin. The clinical presentation is variable, ranging from asymptomatic with incidental laboratory abnormalities to significant bleeding. With the development of human-derived thrombin agents, bovine thrombin is less frequently used. We report a case of an acquired FV inhibitor that developed in a patient after exposure to human thrombin used as a hemostatic agent during an otorhinolaryngology surgical procedure. Our review of the literature revealed only one prior reported case of FV inhibitor after exposure to human thrombin. Hematologists and surgeons should be aware of this rare, but potentially life-threatening, complication in the postprocedural setting.
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Affiliation(s)
- K Donohoe
- Hematology and Oncology, Lenox Hill Hospital, New York, NY, USA
| | - R Levine
- Hematology and Oncology, Lenox Hill Hospital, New York, NY, USA
- Blood Bank, Lenox Hill Hospital, New York, NY, USA
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12
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Kinjo Y, Yoshimura K, Suzuki T, Shinozawa K, Nakasone K, Yoshimata T, Nishihira M, Henzan E. [Development of asymptomatic acquired factor V inhibitor after the administration of antibiotics]. Rinsho Ketsueki 2014; 55:2311-2315. [PMID: 25501413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Acquired factor V (FV) inhibitor is a rare coagulation disorder, the causes and clinical symptoms of which are known to vary widely. Acquired FV inhibitor mostly occurs with exposure to fibrin glues during surgical procedures. We experienced a case with asymptomatic acquired FV inhibitor caused by antibiotic therapy for aspiration pneumonia.A man in his eighties had been treated for chronic atrial fibrillation, cerebral infarction and spinal canal stenosis. He was admitted after antibiotic therapy for aspiration pneumonia in a previous hospital. On admission, the screening test for blood coagulation revealed extreme prolongation of both prothrombin time (PT) and activated partial thromboplastin time (APTT). Vitamin K was administered intravenously after cessation of warfarin, but neither PT nor APTT showed any improvement. Subsequently, a cross mixing test was performed and showed an inhibitor pattern. Furthermore, a high titer of FV inhibitor was detected by the Bethesda method and an acquired FV inhibitor was thus diagnosed. Despite the presence of FV inhibitor, the patient showed no bleeding symptoms. Eight months later, both PT and APTT had diminished to normal clotting time values without immunosuppressive therapies.
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Affiliation(s)
- Yasuyuki Kinjo
- Department of Internal Medicine, Nanbu Tokushukai Hospital
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13
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Croles FN, Beerenhout CH, Mulder AB, Meijer K, Nijziel MR. [AL amyloidosis-associated factor X deficiency]. Ned Tijdschr Geneeskd 2014; 158:A6678. [PMID: 24495369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND An acquired bleeding tendency is a specific symptom that can indicate an underlying disease. CASE DESCRIPTION Here we describe a 69-year-old patient with an acquired bleeding tendency resulting from a factor X deficiency due to an underlying amyloid light-chain (AL) amyloidosis. Factor X deficiency in AL amyloidosis arises from a quantitative and qualitative deficiency of factor X because it binds to amyloid fibrils exposed to circulating blood. CONCLUSION Bleeding tendency is a rare complication of AL amyloidosis, often resulting from a factor X deficiency.
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Khammassi N, Mohsen D, Abdelhedi H, Cherif O. [Acquired combined deficiency of Factor V and VIII]. Tunis Med 2013; 91:291-292. [PMID: 23673718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Abstract
The frequency of menometrorrhagia in adolescence is estimated at 2-5 %. The functional origin is the most common. Hemostasis abnormalities account for 20 % of cases, and they should be sought whenever there is a personal history of known or suggestive of hemostasis disorders (epistaxis, gingival bleeding, postoperative bleeding, bruising, etc.) or there is a family history of hemostasis disorders. Organic origins are rare, but these must be sought when the characteristics of bleeding point in this direction. The workup aims to investigate the cause and assess the impact of the hemorrhage. It may include an NFS, blood group and rhesus±β-HCG, hemostasis evaluation, determination of hemostasis factors, and a pelvic ultrasound. Whatever the cause of menometrorrhagia, the therapeutic options are the same and are oriented by the severity of bleeding. The treatment is mainly medical and hormonal. The surgical option should be a choice of last resort. We report a case of a 13-year-old girl admitted in hemorrhagic shock due to abundant metrorrhagia. Her laboratory tests showed an isolated deficiency of factor V with a 2 % rate. Congenital factor V deficiency is a rare autosomal recessive coagulation disorder. It can be diagnosed at any age when a bleeding disorder of varying severity is observed. The diagnosis is based on the hemostasis evaluation with quantitative determination of factor V. Because no FV-specific concentrate is available, fresh frozen plasma remains the mainstay of treatment. Antifibrinolytics can also be beneficial, and platelet transfusions have been successfully used, associated with hormone therapy. These patients may best be managed in cooperation with both a gynecologist and a hematologist.
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Affiliation(s)
- A Chemaou
- Service d'accueil des urgences pédiatriques, hôpital d'Enfants, CHU Ibn Rochd, Casablanca, Maroc.
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16
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Soff GA. Combined factor V and factor VIII deficiency. Clin Adv Hematol Oncol 2012; 10:474-476. [PMID: 22895292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Gerald A Soff
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
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17
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Dulíček P, Pecka M, Malý J. Factor V and FVIII deficiency in a young Czech woman. Haemophilia 2011; 18:e37. [PMID: 22044494 DOI: 10.1111/j.1365-2516.2011.02690.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Rolla R, Vidali M, Meola S, Pollarolo P, Pergolini P, Bellomo G. Estimating the cost of redundancy in molecular diagnostics: the case of activated protein C resistance and factor V Leiden. Clin Lab 2011; 57:711-717. [PMID: 22029186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The activated protein C resistance--sensitivity ratio in the presence of Factor V deficient plasma (APC-SR/Factor V) exhibits a high sensitivity for factor V Leiden mutation and has been proposed as the diagnostic approach of choice, as an alternative to genetic tests, to evaluate activated protein C resistance. A survey, including 4969 requests, was performed on the activity of a typical Molecular Diagnostics Laboratory in order to estimate the costs due to reagents, instrumentation and personnel. METHODS The global costs of three hypothetical diagnostic approaches were compared: (A) exclusive molecular test for FV Leiden; (B) APC-SR alone; (C) APC-SR and the exclusive confirmation of positive results with molecular test. RESULTS The global cost for each patient with the three approaches investigated were respectively 42.20 euros (A), 1.09 euros (B), and 433 euros (C). The cost for finding a patient with factor V Leiden mutation was 549.00 euros for A, 14.18 euros for B, and 56.32 euros for C. It was calculated that a decrease of 97.42% and 89.74% can be obtained using the approaches B and C, respectively. The difference in cost between B and C can be justified by the avoidance of false positive cases (6%) and by the impossibility of distinguishing homozygous from heterozygous patients using APC-SR exclusively (B). CONCLUSIONS In the case of suspected phenotype APC resistance, we suggest a laboratory approach, which provides the combined and sequential use of ProCGlobal/FV analysis and a subsequent genetic test for positive patients.
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Affiliation(s)
- Roberta Rolla
- Dept of Medical Sciences, University Amedeo Avogadro of East Piedmont, Novara, Italy.
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19
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Ryman A, Hubiche T, Amiral J, Taïeb A, Guerin V. Acquired haemophilia A associated with transitory and severe factor V deficiency during bullous pemphigoid: first report. Thromb Haemost 2009; 101:582-583. [PMID: 19277424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Anne Ryman
- Laboratoire d'Hématologie, Hôpital Universitaire Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France
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20
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Faisal AWK, Hameed S, Ahmad W, Latif M. Coronary artery anomaly with congenital factor V deficiency. J PAK MED ASSOC 2008; 58:650-651. [PMID: 19024144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The case of a 60-years-old woman with coronary artery anomaly and factor V deficiency is reported. She presented with right radial artery pseudoaneurysm after coronary angiography. Her coronary angiography revealed aberrant origin of left anterior descending artery from right coronary cusp. On preliminary investigations her prothrombin time and activated partial thromboplastin time were prolonged. Her plasma factor V level was found out to be 4%, a moderate deficiency of factor V.
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21
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Geranmayeh F, Usman S, Bhutiani R. Jejunal ischaemia-- rare aetiologies and a surgical dilemma. Acta Gastroenterol Belg 2008; 71:263-266. [PMID: 18720940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Superior Mesenteric Artery thrombosis can lead to acute mesenteric ischaemia with devastating consequences. The main dilemma for the surgeon is the delay in diagnosis and a definitive treatment, as these patients may present with signs of peritonism but not frank peritonitis until the ischaemia results in infarction and or perforation. We report a detailed literature search and a unique case of jejunal ischaemia in the setting of undiagnosed Antiphospholipid Syndrome and Factor V Leiden heterozygosity where a delayed diagnosis resulted in an unnecessary prolongation of patient's morbidity.
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Affiliation(s)
- F Geranmayeh
- Department of surgery, Central Middlesex Hospital, North West London Hospitals NHS trust, London NW10 7NS, UK
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22
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Borucki K, Töpfer G, Hartung KJ, Lutze G. [Hereditary factor V deficiency and factor V inhibitor without bleeding. Rare causes of pathological screening tests of coagulation]. Hamostaseologie 2007; 27:188-90. [PMID: 17694226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Isolated reduction in factor V activity either occur in form of a hereditary deficiency of factor V as an acquired inhibitor against factor V. Diagnosis can not be made by bleeding alone because in both cases it can occur or not occur. Two patients were investigated showing pathological screening tests of coagulation without bleeding. A hereditary and an acquired deficiency of factor V were proved.
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Affiliation(s)
- K Borucki
- Institut für Klinische Chemie und Pathobiochemie, Otto-von-Guericke Universität Magdeburg, Leipziger Str. 44, 39120 Magdeburg.
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23
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Ulusal Okyay G, Coşkun Yenigün E, Darilmaz Yüce G, Yildirim IS, Ardiç S. Life threatening chylothorax in a patient with congenital thrombophilia: case report. Tuberk Toraks 2007; 55:404-408. [PMID: 18224511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
We reported here a case of bilateral chylothorax as a result of widespread thrombi formation in a patient who was heterozygote for factor V leiden gene mutation and who had antithrombin III deficiency. We performed bilateral chest tubes, thrombolytic and oral anticoagulant therapy. The patient responded to the therapy. She has been in follow up without symptoms for 18 months.
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Affiliation(s)
- Gülay Ulusal Okyay
- Department of Internal Medicine, Dişkapi Yildirim Beyazit Education and Research Hospital, Government of Health, Ankara, Turkey.
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24
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Perdekamp MTG, Rubenstein DA, Jesty J, Hultin MB. Platelet factor V supports hemostasis in a patient with an acquired factor V inhibitor, as shown by prothrombinase and tenase assays. Blood Coagul Fibrinolysis 2006; 17:593-7. [PMID: 16988558 DOI: 10.1097/01.mbc.0000245297.64644.ee] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A woman with gross hematuria was shown to have a severe isolated factor V deficiency due to a factor V inhibitor of 200 U/ml titer. Hematuria persisted despite multiple infusions of plasma but, after one transfusion with 1 U platelets, urine red blood cells decreased by more than 98%. To evaluate the patient's platelet function we performed prothrombinase and tenase assays with platelets from the patient and from normal donors. By prothrombinase assay, ionophore-activated patient platelets showed 42% of the activity of normal platelets in their ability to support prothrombin activation by activated factor X; whereas in a 'tenase' assay, which measures the platelets' ability to support factor X activation by activated factor IX + activated factor VIII, their activity was 117% of normal. The addition of excess bovine activated factor V to the prothrombinase assay fully corrected the defect. The results demonstrate the benefit of platelet transfusion and indicate that in this case the platelets are the primary source of factor V for hemostasis.
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25
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Vellinga S, Steel E, Vangenechten I, Gadisseur A. Successful pregnancy in a patient with factor V deficiency: case report and review of the literature. Thromb Haemost 2006; 95:896-7. [PMID: 16676084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- Sanne Vellinga
- Antwerp University Hospital, Department of Hematology, Belgium
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26
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Preston FE, Jennings I, Kitchen DP, Woods TA, Kitchen S. Variability in factor V:C assays in UK National External Quality Assessment Scheme surveys: there is a need for an international standard. Blood Coagul Fibrinolysis 2005; 16:529-31. [PMID: 16175014 DOI: 10.1097/01.mbc.0000183118.66605.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Severe familial factor V:C deficiency is a rare, recessively inherited coagulation disorder but there is little information in respect of the accuracy and reliability of factor V:C assays that are required for diagnosis and treatment monitoring. We present here the results of three External Quality Assessment exercises in respect of factor V:C assays undertaken by 192--225 participating laboratories performed over a 2-year period. Consistent significant differences were observed between results obtained using different reference plasmas and different thromboplastins. The relationship between results obtained with different reference plasmas was not constant and varied between the surveys. In-house studies confirmed the observation derived from the External Quality Assessment surveys that the choice of commercial reference plasma significantly affects the results of factor V:C assays. These results clearly indicate the necessity for an international standard for factor V:C.
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Affiliation(s)
- F Eric Preston
- United Kingdom National External Quality Assessment Scheme (UK NEQAS) for Blood Coagulation, Sheffield, UK.
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27
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Affiliation(s)
- J F Lucia
- Department of Haematology, Hospital Universitario Miguel Servet, Zaragoza, Spain
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28
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Amano K, Fukutake K. [Factor V]. Nihon Rinsho 2004; 62 Suppl 12:632-5. [PMID: 15658409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- Kagehiro Amano
- Department of Laboratory Medicine, Tokyo Medical University
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29
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Faioni EM, Castaman G, Asti D, Lussana F, Rodeghiero F. Association of factor V deficiency with factor V HR2. Haematologica 2004; 89:195-200. [PMID: 15003895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Factor V HR2 possesses decreased co-factor activity to activated protein C and an increased ratio of factor V1 to factor V2. Factor V HR2 is associated with a mild increase in the risk of venous thromboembolism although not all studies concur on this point. DESIGN AND METHODS Inconsistencies in results of the epidemiological studies may stem from a failure to identify other variables in factor V which might contribute to an increased risk of thrombosis in selected HR2 carriers. The aim of this study was to establish whether factor V deficiency increases the risk of venous thromboembolism when associated with HR2. RESULTS Four hundred and ninety-seven patients with venous thromboembolism and 498 controls were studied. HR2 was present in 12.5% of patients and 10.4% of controls. Factor V deficiency was associated with HR2 in 4.6% of patients and 1.0% of controls. The OR for venous thromboembolism in individual with HR2 alone was 1.2 (95% CI 0.8-1.8), while it was 4.7 (95% CI 1.8-12.5) for those with HR2 plus factor V deficiency. INTERPRETATION AND CONCLUSIONS Patients with HR2 and factor V deficiency developed a thrombotic event earlier (median age 35 years) than patients with HR2 alone (median age 43 years, p = 0.018). Double heterozygosity for HR2 and a factor V defect, including factor V deficiency, increased the thrombotic risk afforded by HR2.
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Affiliation(s)
- Elena M Faioni
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Maggiore Hospital and Department of Internal Medicine, University of Milan, Italy
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30
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Affiliation(s)
- Simona Sacco
- Department of Neurology, University of L'Aquila, L'Aquila, Italy
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31
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Ajzner E, Balogh I, Haramura G, Boda Z, Kalmár K, Pfliegler G, Dahlbäck B, Muszbek L. Anti-factor V auto-antibody in the plasma and platelets of a patient with repeated gastrointestinal bleeding. J Thromb Haemost 2003; 1:943-9. [PMID: 12871359 DOI: 10.1046/j.1538-7836.2003.00143.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Development of autoantibody against coagulation factor V (FV) is a rare clinical condition with hemorrhagic complications of varying severity. The aim of this study was to establish the pathomechanism of an acquired FV deficiency and characterize the FV inhibitor responsible for the clinical symptoms. A 78-year-old female was admitted to hospital with severe gastrointestinal bleeding. General clotting tests and determination of clotting factors were performed by standard methods. FV antigen and FV containing immune complexes were measured by ELISA. The FV molecule was investigated by Western blotting and by sequencing the f5 gene. The binding of patient's IgG to FV and activated FV (FVa) was demonstrated in an ELISA system and its effect on the procoagulant activity of FVa was tested in clotting tests and in a chromogenic prothrombinase assay. Localization of the epitope for the antibody was performed by blocking ELISA. FV activity was severely suppressed both in plasma and platelets. FV antigen levels were normal by ELISA using polyclonal anti-FV antibody or monoclonal antibody against the connecting region of FV, but depressed when HV1 monoclonal antibody against the C2 domain in the FV light-chain was used as capture antibody. The FV molecule was found intact. An IgG reacting with both FV and FVa was present in the patient's plasma and its binding to FV was inhibited by HV1 antibody. FV-containing immune complexes were detected in the patient's plasma and platelet lysate. The patient's IgG inhibited the procoagulant function of FVa. An anti-FV IgG was present in the patient's plasma and platelets. The autoantibody reacted with an epitope in the C2 domain of FV light chain and neutralized the procoagulant function of FVa.
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Affiliation(s)
- E Ajzner
- Department of Clinical Biochemistry and Molecular Pathology, University of Debrecen, Medical and Health Science Center, Debrecen, Hungary
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32
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Emori Y, Sakugawa M, Niiya K, Kiguchi T, Kojima K, Takenaka K, Shinagawa K, Ishimaru F, Ikeda K, Tanimoto M, Yamasaki R, Ohara N, Harada M. Life-threatening bleeding and acquired factor V deficiency associated with primary systemic amyloidosis. Blood Coagul Fibrinolysis 2002; 13:555-9. [PMID: 12192308 DOI: 10.1097/00001721-200209000-00011] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Acquired factor X deficiency has been described in patients with amyloidosis but acquired factor V deficiency is quite rare. We report here a case of life-threatening bleeding and acquired factor V deficiency associated with primary amyloidosis. A 50-year-old man who had no previous hemorrhagic diathesis was referred to our hospital because of recurrent epistaxis, gingival bleeding and hemospermia. The laboratory examination revealed that both the prothrombin time (PT) and the activated partial thromboplastin time (aPTT) were significantly prolonged, and factor V activities were markedly decreased to 14-39% of the normal value. Other coagulation factors such as fibrinogen, prothrombin, factor VII, factor VIII, factor IX and factor X were subnormal and normal. Transaminases were slightly elevated but serological tests of hepatitis B and hepatitis C were negative. Mild hepatosplenomegaly was noted without sign of liver cirrhosis. The PT and aPTT obtained 8 years ago when he received a cholecystectomy due to cholecystitis were both normal. Specific assays for the detection of factor V inhibitor were repeatedly performed but no factor V inhibitor was found. Furthermore, a significant recovery of the infused factor V was noted shortly after an intravenous administration of 5-10 U fresh frozen plasma, but it did not last more than 6 h. Melena, bleedings into the left shoulder and buttock, and finally mortal retroperitoneal hemorrhage developed despite repeated infusions of large amounts of fresh frozen plasma. Acquired factor V deficiency associated with primary amyloidosis was suspected but histological diagnosis was not obtained because of the severe bleeding tendency. Autopsy revealed hepatosplenomegaly and massive deposits of AL amyloid in the liver, spleen, heart and other parenchymal organs. Perivascular amyloid deposition and factor V deficiency are both thought to be the cause of the severe hemorrhagic tendency seen in this patient.
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Affiliation(s)
- Y Emori
- Second Department of Medicine, Okayama University Medical School, Japan
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33
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Shukla J, Singhal R, Garbyal RS, Singh VP, Dube B. Hereditary combined coagulation factor V and factor VIII deficiency: report of two Indian families from Varanasi. INDIAN J PATHOL MICR 2002; 45:151-4. [PMID: 12696729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Hereditary deficiencies of blood coagulation factors usually involve a single protein defect. Herewith we are describing clinical features and laboratory approach for the diagnosis of combined coagulation factor V/VIII deficiency which we encountered in 3 patients from 2 unrelated Hindu families of Varanasi.
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Affiliation(s)
- Jyoti Shukla
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi
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34
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Anikó M, Eniko A, Edina M, Teréz S, Eva A. [Severe congenital factor V deficiency: case report]. Orv Hetil 2002; 143:87-9. [PMID: 11868454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Congential deficiency of factor V is a rare condition, transmitted in autosomal recessive way. Heterozygote patients generally have no symptoms, homozygotes present with spontaneous and postoperative bleedings. About one-half of patients are diagnosed in adulthood. METHODS The presented case is a double heterozygote, which was confirmed using moleculare biological methods. The authors found many carriers in his family. CONCLUSIONS This rare and sometimes severe disorder needs regular haematological controls. Carriers must have more attention during surgical procedures and labour, and the family doctor should be informed about there condition.
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Affiliation(s)
- Marosi Anikó
- Fovárosi Onkormányzat Heim Pál Gyermekkórház, Budapest, Hematológiai Osztály
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35
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Pavithran K, Sankar S, Thomas M. Late presentation of congenital factor V deficiency--a case report. Indian J Med Sci 2001; 55:271-2. [PMID: 11641920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
Congenital factor deficiency is a rare coagulation disorder, which is inherited in an autosomal recessive manner. The severity of bleeding symptoms in general is only partially related to the degree of factor V deficiency in plasma. In this report, a boy presenting with hemarthrosis in his late adolescence due to congenital factor V deficiency is reported.
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Affiliation(s)
- K Pavithran
- Medical College Hospital, Thiruvananthapuram-695011
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36
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Bach KP, Schouten-van Meeteren AY, Smit LM, Veenhuizen L, Gemke RJ. [Intracranial hemorrhages in infants: child abuse or a congenital coagulation disorder?]. Ned Tijdschr Geneeskd 2001; 145:809-13. [PMID: 11370424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
In children with head injuries the severity of the neurological symptoms should concord with the patient's history and signs of neurotrauma on examination. Discrepancies between the (hetero)anamnesis and physical examination on the one hand and neurological findings on the other may indicate child abuse. The presence of both old and new intracranial haemorrhages in the absence of proportional trauma is generally considered as evidence for child abuse. However, these symptoms may also be the first manifestation of a congenital coagulation disorder. Three children, two girls aged 8 and 5 months and a boy aged 6 months were presented with alarming neurological symptoms due to intracranial haemorrhages without external signs of head trauma. The first girl had 'shaken baby' syndrome while the other 2 had congenital coagulation disorders (haemophilia B and factor V deficiency, respectively). All three recovered, the last two with remaining one-sided neurological deficits. Child abuse and congenital coagulation disorders may present with similar neurological symptoms and radiological findings. In these patients coagulation tests are mandatory and--if abnormal--enable early substitution of deficits and prevent inappropriate suspicion or accusation of caretakers.
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Affiliation(s)
- K P Bach
- Academisch Ziekenhuis Vrije Universiteit, afd. Kindergeneeskunde, Postbus 7057, 1007 MB Amsterdam
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37
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Hough RE, Makris M. Recent onset of bleeding and gross coagulopathy. Postgrad Med J 2001; 77:53, 57-8. [PMID: 11123401 PMCID: PMC1741883 DOI: 10.1136/pmj.77.903.53a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- R E Hough
- Department of Haematology, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK
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38
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Montefusco MC, Duga S, Asselta R, Santagostino E, Mancuso G, Malcovati M, Mannucci PM, Tenchini ML. A novel two base pair deletion in the factor V gene associated with severe factor V deficiency. Br J Haematol 2000; 111:1240-6. [PMID: 11167768 DOI: 10.1046/j.1365-2141.2000.02456.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We studied a family in which the proband, a 13-year-old boy, had unmeasurable plasma levels of coagulation factor V antigen and activity. Clinical symptoms were severe, with several episodes of haemorrhages in the mucosal tracts (gastrointestinal, nose and urinary) and recurrent haemarthroses that caused permanent arthropathy. Sequence analysis of the factor V gene demonstrated the presence of a novel 2 base pair (bp) homozygous deletion in exon 13 at positions 2833-2834. This mutation, present in the heterozygous state in the asymptomatic mother and absent in the healthy brother, introduced a frameshift and a premature stop at codon 900. This would predict the synthesis of a truncated factor V molecule, lacking part of the B domain and the complete light chain. Because of the existence of a surveillance mechanism that selectively recognizes and degrades mRNA molecules carrying premature termination codons, we analysed the relative abundance of mutant vs. wild-type mRNA molecules in the platelets of the heterozygous proband's mother. The mutant mRNA was significantly reduced in amount (mutant/wild-type ratio 0.35). This is the first reported mutation in the factor V gene causing severe factor V deficiency, the effect of which was quantitatively analysed at mRNA level.
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Affiliation(s)
- M C Montefusco
- Department of Biology and Genetics for Medical Sciences, University of Milan, Italy
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39
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Islam SI, Quadri MI. Spectrum of hereditary coagulation factor deficiencies in eastern province, Saudi Arabia. East Mediterr Health J 1999; 5:1188-95. [PMID: 11924110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
In a 7-year retrospective analysis (1991-97) of the records of the Department of Haematology, Regional Laboratory and Blood Bank (Dammam), 54 patients from all parts of Saudi Arabia's Eastern Province were diagnosed with hereditary coagulation factor deficiencies. The largest group of patients, 42 haemophiliacs, included 4 non-Saudi patients. There were 39 haemophilia A or factor VIII deficiency patients, 2 haemophilia B or factor IX deficiency patients and 1 combined factor VIII and V deficiency patient. There were 5 Saudi patients with probable factor XIII deficiency, and 7 patients, all but one who were Saudi, had von Willebrand disease. The distribution of haemophilia patients in Eastern Province showed some differences compared with those reported from Riyadh and from Western countries. Among Saudis in Eastern Province, the number with suspected factor XIII deficiency, although low, was higher than that reported for other regions. The number of patients with haemophilia B and von Willebrand disease was lower than expected, when compared with the number of haemophilia A cases.
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Affiliation(s)
- S I Islam
- Department of Haematology, Regional Laboratory and Blood Bank, Ministry of Health, Dammam, Saudi Arabia
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Dubreuil Lastrucci RM, Dawson DA, Bowden JH, Marion Münster M. Development of a simple multiplex polymerase chain reaction for the simultaneous detection of factor V Leiden and prothrombin 20210A mutations. Mol Diagn 1999; 4:247-50. [PMID: 10553025 DOI: 10.1016/s1084-8592(99)80028-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The demand for thrombophilia testing at the molecular level is increasing, and consequently, the work load of the routine molecular laboratory is also increasing. Efforts to lighten the work load, economize on time, and strive for reduced costs while still maintaining quality assurance are thus necessary. METHODS AND RESULTS A multiplex polymerase chain reaction (PCR) for the detection of factor V Leiden and prothrombin 20210A mutations was designed that enables the use of the same inexpensive restriction enzyme, controls for the digestion, and produces easily interpretable results. CONCLUSION The use of this new multiplex PCR and digestion analysis enabled us to simultaneously perform a routine screen for factor V Leiden and prothrombin 20210A mutations.
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Affiliation(s)
- R M Dubreuil Lastrucci
- Department of Haematology, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
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41
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Rossi V, Di Rocco N, Del Sonno C, Crivelli S. [The concomitant presence of prohemorrhagic and thrombophilic changes in coagulation factor V: a severe defect of coagulant activity and homozygote resistance to activated protein C]. Ann Ital Med Int 1999; 14:127-9. [PMID: 10399376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
We describe the peculiar and concomitant presence of a severe coagulation defect predisposing to bleeding and a mutation associated with inherited thrombophilia. A 6-year-old boy had a severe deficiency in factor V procoagulant activity and antigen and yet remained asymptomatic. This paradox might be explained by the hypothesis of the simultaneous presence of a thrombophilic disorder that might have restored hemostatic balance. The boy was a homozygous carrier of the Arg506Gln mutation of coagulation factor V, that renders this factor resistant to inactivation by its naturally occurring inhibitor, activated protein C. The family members, none of whom had bleeding or thrombotic symptoms, were heterozygotes for either the bleeding or the thrombophilic defect. Despite the severity of the bleeding defect, the absence of bleeding symptoms in the boy can be explained by the hypothesis that any residual amount of factor V present in his plasma is resistant to inactivation by activated protein C.
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Affiliation(s)
- V Rossi
- Dipartimento di Medicina Interna, IRCCS Ospedale Maggiore, Milano
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42
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Abstract
Factor V deficiency is a rare coagulation disorder which is inherited autosomal recessively. Factor V deficiency should be considered in infants with bleeding disorders and prolonged prothrombin and activated partial thromboplastin times if bleeding continues in spite of vitamin K injection. In this article, the case of an infant with an intracranial haemorrhage due to congenital factor V deficiency is reported.
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Affiliation(s)
- M Totan
- Medical Faculty of Ondokuz Mayis University, Department of Paediatric Haematology, Samsun, Turkey
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43
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Takamatsu J. [Congenital factor V deficiency/abnormal factor V]. Ryoikibetsu Shokogun Shirizu 1998:439-41. [PMID: 9833537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- J Takamatsu
- Department of Transfusion Medicine, Nagoya University Hospital
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44
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Takamatsu J. [Congenital combined deficiency of factor V and factor VIII]. Ryoikibetsu Shokogun Shirizu 1998:437-8. [PMID: 9833536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- J Takamatsu
- Department of Transfusion Medicine, Nagoya University Hospital
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45
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46
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Koek GH, Blockmans DE, Van Hootegem P. [Three patients with a kidney infarct]. Ned Tijdschr Geneeskd 1998; 142:2473-6. [PMID: 10028329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Two patients, one 76-year-old-man and one 79-year-old-woman with cardiovascular disease and one 36-year-old-man with Factor-V-Leiden deficiency (activated protein C-resistance) had abdominal pain and elevation of LDH levels. With abdominal CT scan kidney infarction was diagnosed. In two cases a selective kidney arteriography was performed to confirm the diagnosis. Treatment consisted of (re)starting anticoagulant therapy. In unexplained abdominal pain with insufficiently specific results of physical examination combined with a rapid rise of the LDH and sometimes of the serum creatinine, a kidney infarction should be considered in the differential diagnosis.
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Affiliation(s)
- G H Koek
- Universitaire Ziekenhuizen, Gasthuisberg, afd. Interne Geneeskunde, Leuven, België
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47
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Haas FJ, van Sterkenburg-Kamp BM, Scheepers HA. A protein C pathway (PCP) screening test for the detection of APC resistance and protein C or S deficiencies. Semin Thromb Hemost 1998; 24:355-62. [PMID: 9763352 DOI: 10.1055/s-2007-996023] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A new automated method for screening defects in the Protein C Pathway (PCP) was evaluated. The "PCP test" is based on a phospholipid-rich Russells viper venom reagent, insensitive to heparin and lupus anticoagulants. To minimize interference from other clotting variables, ratios of the clotting time with and without the addition of a protein C activator were usually determined. Plasma samples from healthy volunteers, patients untreated or on oral anticoagulants, patients with factor V Leiden with and without treatment, and patients with protein C and/or S deficiencies were tested. Mixing patient plasmas 1:1 with individual plasmas deficient in factor V, protein C or S was evaluated for identifying the nature of defects by shortening the screening test. The PCP test was found to be sensitive to APC resistance due to factor V Leiden and by mixing with factor V deficient plasma was also useful despite the effects of oral anticoagulants. Results in the group of patients with previous low protein C or S levels suggest that the method has a better sensitivity to protein C than to protein S deficiency. The automated test was simple to use and gave a between-run coefficient of variation below 3% on normal plasmas.
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Affiliation(s)
- F J Haas
- St. Antonius Hospital, Nieuwegein, The Netherlands
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48
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Girolami A, Simioni P, Scarano L, Girolami B, Marchiori A. Hemorrhagic and thrombotic disorders due to factor V deficiencies and abnormalities: an updated classification. Blood Rev 1998; 12:45-51. [PMID: 9597197 DOI: 10.1016/s0268-960x(98)90029-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The recent description of a factor V abnormality (factor V Leiden) associated with an increased incidence of thrombosis has considerably increased interest in this clotting factor. The discovery of this new clinical entity indicated the need for an updated classification of factor V defects. These should be divided into hemorrhagic and thrombotic disorders. A proper classification of hemorrhagic disorders should include: 1) homozygous and heterozygous 'true' factor V deficiency; and 2) combined factor V and factor VIII deficiencies. The latter should be subdivided in Type I (association type) and Type II (common defect). A suitable classification of the thrombotic factor V defects should include: 1) homozygous and heterozygous factor V Leiden; and 2) combined heterozygous factor V Leiden and heterozygous 'true' factor V deficiency. The presence of thrombosis in these latter patients, often as severe as those seen in homozygous patients with activated protein C (APC) resistance, allows important considerations on the functions of factor V. It would seem that half the normal level of factor V activity and antigen is unable to protect against thrombosis in patients with heterozygous APC resistance. An accurate evaluation of factor V activity and antigen is indicated in all patients with suspected factor V defects. The first suspicion may be obtained by the presence of a mild prolongation of prothrombin time and of partial thromboplastin time. The suspicion should then be immediately confirmed by specific factor V activity and antigen assays. This approach is of great importance even for the presumptive diagnosis of pseudohomozygosis for APC resistance. In fact, in these cases, factor V activity is about 50% of normal, whereas factor V antigen is 100% of normal. In heterozygous 'true' factor V deficiency both activity and antigen are about 50% of normal.
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Affiliation(s)
- A Girolami
- University of Padua Medical School, Institute of Medical Semeiotics, Italy
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Páramo JA, López Y, Muñoz C, Rodríguez-Calvillo M, Panizo C. [Diagnosis of hypercoagulable states]. Sangre (Barc) 1997; 42:493-502. [PMID: 9490914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- J A Páramo
- Servicio de Hematología, Universidad de Navarra, Pamplona
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50
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Sapuri M, Amoa AB, Kariwiga G, White J. A case of factor V deficiency presenting as menorrhagia. P N G Med J 1997; 40:92-5. [PMID: 10513230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Factor V deficiency is a rare hereditary disorder. We report a patient with factor V deficiency who presented with menorrhagia and pelvic haematoma. The Haematology Department at the Royal Brisbane Hospital performed the definitive factor assays leading to the diagnosis. The challenges of her management were obtaining adequate supplies of factor V and her socioeconomic circumstances. The main future challenge will be the supervision of her pregnancies.
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Affiliation(s)
- M Sapuri
- Department of Clinical Sciences, University of Papua New Guinea, Papua New Guinea
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