A 71-yr-old male was seen because of the development of severe bleeding diathesis secondary to an acquired factor V inhibitor. The lack of clinical and laboratory response to fresh frozen plasma prompted us to treat him with platelet transfusions during 4 separate bleeding episodes; on each occasion he received 1 0-1 5 U of homologous platelet concentrates. There was a remarkable clinical response associated with a marked correction of the prolonged prothrombin time. prolonged partial thromboplastin time. and prolonged Russell viper venom time; this correlated with higher factor V levels and complete neutralization of the inhibitor. The beneficial effect of platelet transfusion lasted 5-6 days. The inhibitor was of low titer. and it was precipitated by staphylococcal protein A. The in vivo response to platelet transfusion correlated with subsequently performed in vitro experiments. Nonwashed control platelet pellets mixed with inhibitor plasma partially corrected the prolonged PTT. whereas washed platelets or albumin density gradient separated
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