Acquired factor V inhibitor after exposure to topical human thrombin related to an otorhinolaryngological procedure

Donohoe, Kelsey; Levine, Randy L.

doi:10.1111/jth.13114

Cited by 12 publications

(12 citation statements)

References 15 publications

(21 reference statements)

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“…Factor V (FV) plays an essential role in the coagulation cascade; it is a cofactor necessary for the prothrombinase complex to activate prothrombin into thrombin [ 1 , 2 ]. Congenital FV deficiency is rare; it is estimated that 1 in 1, 000,000 people are affected [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

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Successful Management of Life-threatening Pelvic Hemorrhage From Acquired Factor V Deficiency With immunosuppressive Therapy

Wu¹,

Gowda²,

Peng³

et al. 2020

Cureus

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Acquired Factor V deficiency is a rare and challenging condition to treat. It has been associated with major surgeries, antibiotics, blood transfusions, infections, autoimmune disorders, malignancy and exposure to bovine thrombin. The clinical presentation can be heterogeneous and can manifest as asymptomatic laboratory abnormalities to fatal hemorrhage with mortality rates around 15-20% . We report a case of acquired factor V deficiency in which the patient developed a life-threatening bleeding coagulopathy with elevated prothrombin time, activated partial thromboplastin time and factor V inhibitor titers following multiple surgical procedures that were performed after a motor vehicle accident. The patient was successfully treated with immunosuppressive therapy including steroids and cyclophosphamide resulting in the complete elimination of inhibitor levels.

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Section: Discussionmentioning

confidence: 99%

“…Antibodies can develop against bovine factor V found in small amounts in the glue resulting in a cross-reaction with human factor V [ 4 ]. FV inhibitors have also been described after exposure to human thrombin, which is very rare [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Successful Management of Life-threatening Pelvic Hemorrhage From Acquired Factor V Deficiency With immunosuppressive Therapy

Wu¹,

Gowda²,

Peng³

et al. 2020

Cureus

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“…The remaining six patients were treated with heparin (LMWH or unfractionated heparin) during the initial phase followed by anti-vitamin K or oral anticoagulants. [6,[13][14][15] The treatment with heparin helped towards a favorable evolution of thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Transient FV inhibitor of unknown origin in difficult clinical situation

Pointeau

Marot

Suhl

et al. 2017

CRIM

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Acquired Factor V inhibitors are a rare condition, associated frequently with at times severe bleeding. Patients can show no symptoms and in exceptional cases thrombosis can be reported. In this article we report two cases of acquired FV inhibitors associated with thrombosis. We systematically reviewed the literature on FV inhibitors and thrombosis. A patient had acquired FV inhibitors and thrombosis. He had no bleeding and was treated with anticoagulant. Despite initial improvement, he died from legionaire's disease. The second patient had septicemia, acquired FV inhibitors and deep vein thrombosis. The patient's condition improved with anticoagulation and antibiotic therapy. Ten case reports were considered in the systematic review. The median age at admission was 67. Seven patients had bleeding episodes. The median peak inhibitor titer was 2.7 BU (0.62-8) while the median FV activity was 2% (1-75). Except for 2 patients, all recovered. FV has two activities: a procoagulant action activating prothrombin, as well as an anticoagulant action activating protein C. This property could be associated with thrombosis activity. Inhibitor could also have a through effect on activated protein C. In our study, because of underlying diseases, it was not possible to clearly demonstrate that inhibitors give thrombosis. Immunosuppressive therapies were administered in cases of severe bleeding. Heparin seemed efficient for thrombosis without major bleeding. The prognosis of acquired FV inhibitors appeared to be related to the underlying disease.

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“…144 Bovine thrombin is no longer in use, but an anti-FV antibody should be in the differential diagnosis of FV deficiency after surgery. 145 Laboratory testing. Anaemia is frequently reported (36%) in homozygous FV deficiency.…”

Section: Rbd In Extrinsic Pathwaymentioning

confidence: 99%

Perioperative management of rare coagulation factor deficiency states in cardiac surgery

Strauss

Mazzeffi

Williams

et al. 2017

British Journal of Anaesthesia

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Rare bleeding disorders (RBDs) include the hereditary deficiency of fibrinogen, factor (F)II, FV, FV + FVIII, FVII, FX, FXI or FXIII. RBDs do not confer a protective effect against atheromatous plaque formation, and thus the need for cardiovascular (CV) surgery in RBD patients is expected to increase with improved healthcare access (diagnosis and management) and longevity of the population. Clinical data regarding the management of RBDs in this setting are sparse, but the perioperative care team is obliged to gain a better understanding on available biological and pharmacological hemostatic agents. Perioperative management of RBDs in CV surgery is further complicated by heparin anticoagulation, haemodilution, and consumption of procoagulant and anticoagulant proteins associated with cardiopulmonary bypass (CPB). The aims of this review are to summarize pathophysiology of RBDs and laboratory monitoring pertinent to CV surgery, available factor replacement agents, and to provide the framework for perioperative coagulation management of RBD patients.

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Acquired factor V inhibitor after exposure to topical human thrombin related to an otorhinolaryngological procedure

Cited by 12 publications

References 15 publications

Successful Management of Life-threatening Pelvic Hemorrhage From Acquired Factor V Deficiency With immunosuppressive Therapy

Successful Management of Life-threatening Pelvic Hemorrhage From Acquired Factor V Deficiency With immunosuppressive Therapy

Transient FV inhibitor of unknown origin in difficult clinical situation

Perioperative management of rare coagulation factor deficiency states in cardiac surgery

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