Iatrogenic acquired factor V inhibitors: A case report and review of the French pharmacovigilance database

Théron, Alexandre; Burcheri, Sara; Vacheret, Fabienne; Hillaire‐Buys, Dominique; Sauguet, Pauline; Schved, Jean‐François; Faillie, Jean‐Luc; Biron‐Andréani, Christine

doi:10.1016/j.thromres.2017.06.007

Cited by 4 publications

(4 citation statements)

References 10 publications

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“…Treatment of the underlying cause that triggered factor inhibitor production often results in disappearance of the inhibitor 2 . Occasionally, spontaneous remission occurs and appears related to initiation and then withdrawal of a new medication (usually antibiotics) 4,6 …”

Section: Discussionmentioning

confidence: 99%

“…No current recommendations are available on the number of platelet transfusions to administer to patients after HSCT because treatment is dependent on the extent, location, and nature of the patient's bleeding. Some studies in the human medical literature cite 1 U of platelets per day whereas others have used 2 U per day during diffuse bleeding episodes 3,4,6 . These differences highlight the difficulty of diagnosing this condition after a procedure that can confound coagulation results as a result of myelo‐inactivation.…”

Section: Discussionmentioning

confidence: 99%

“…Information on factor inhibition in both the human and veterinary medical literature is sparse 1 . Acquired factor inhibitors have been identified in human patients in association with medications, malignancies, autoimmune disorders, pregnancy, infections, idiopathic causes, and less commonly in patients receiving bovine thrombin products for hemostasis 2‐6 . To our knowledge, a single case report described a human patient who developed FV inhibition after hematopoietic stem cell transplantation (HSCT) 7 .…”

Section: Introductionmentioning

confidence: 99%

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Acquired factor V inhibitors after allogeneic hematopoietic stem cell transplantation in a dog

Masciana

Peterson

Chretin

2020

Veterinary Internal Medicne

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Objective: Describe the clinical course and management of a dog that underwent hematopoietic stem cell transplantation (HSCT) for treatment of B-cell lymphoma and developed acquired circulating factor V (FV) inhibitors. Case Summary: An 8-year-old male castrated Briard dog diagnosed with lymphoma (IVb, B-cell) presented for allogeneic HSCT. Despite multiple platelet, fresh frozen plasma, and red blood cell transfusions prolonged recovery and clinical bleeding occurred. Circulating acquired FV inhibitors were identified and hemorrhage subsequently was managed by immunosuppression. The dog was discharged when clinical resolution of bleeding was achieved. New or Unique Information Provided: This case report describes a dog undergoing curative intent treatment for lymphoma, and subsequently acquiring factor inhibition, and was successfully managed. Specific coagulation screening to assess for coagulation factor deficiencies or inhibitors is essential in the diagnosis and treatment of patients with refractory bleeding or only transient response to blood transfusion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acquired factor V inhibitors after allogeneic hematopoietic stem cell transplantation in a dog

Masciana

Peterson

Chretin

2020

Veterinary Internal Medicne

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“…After their description in late 1950s, 16,17 FV inhibitors were described in the setting of surgical exposure to bovine thrombin 18–21 or following transfusion of fresh frozen plasma in patients with severe congenital FV deficiency 12,22,23 . Nowadays, AFVI is mostly drug‐induced 23–25 . Treatment of AFVI is empiric and based on corticosteroids or intravenous immunoglobulins (IVIG), and transfusion support in patients with severe bleeding 3,26 .…”

Section: Introductionmentioning

confidence: 99%

Acquired factor V inhibitor: a nation‐wide study of 38 patients

et al. 2021

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Summary Acquired factor V inhibitor (AFVI) is an extremely rare disorder that may cause severe bleeding. To identify factors associated with bleeding risk in AFVI patients, a national, multicentre, retrospective study was made including all AFVI patients followed in 21 centres in France between 1988 and 2015. All patients had an isolated factor V (FV) deficiency <50% associated with inhibitor activity. Patients with constitutional FV deficiency and other causes of acquired coagulation FV deficiencies were excluded. The primary outcome was incident bleeding and factors associated with the primary outcome were identified. Thirty‐eight (74 [36–100] years, 42·1% females) patients with AFVI were analysed. Bleeding was reported in 18 (47·4%) patients at diagnosis and in three (7·9%) during follow‐up (7 [0·2–48.7] months). At diagnosis, FV was <10% in 31 (81·6%) patients. Bleeding at diagnosis was associated with a prolonged prothrombin time that strongly correlated with the AFVI level measured in plasma {r = 0·63, 95% confidence interval (CI) [0·36–0·80], P < 0·05}. Bleeding onset during follow‐up was associated with a slow AFVI clearance (P < 0·001). The corresponding receiver operating characteristics curve showed that AFVI clearance was predictive of bleeding onset with an AFVI clearance of seven months with a sensitivity of 100% (95% CI: 29–100) and a specificity of 86% (95% CI: 57–98, P = 0·02). Kaplan–Meier analysis showed that AFVI clearance >7 months increased the risk of bleeding by 8 (95% CI: [0·67–97], P = 0·075). Prothrombin time at diagnosis and time for clearance of FV inhibitor during follow‐up are both associated with bleeding in patients with AFVI.

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Rare acquired factor V inhibitors combined with positive lupus anticoagulant that successfully treated by plasmapheresis and prednisone acetate: a typical case report

Liu

et al. 2023

Ann Hematol

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Iatrogenic acquired factor V inhibitors: A case report and review of the French pharmacovigilance database

Cited by 4 publications

References 10 publications

Acquired factor V inhibitors after allogeneic hematopoietic stem cell transplantation in a dog

Acquired factor V inhibitors after allogeneic hematopoietic stem cell transplantation in a dog

Acquired factor V inhibitor: a nation‐wide study of 38 patients

Rare acquired factor V inhibitors combined with positive lupus anticoagulant that successfully treated by plasmapheresis and prednisone acetate: a typical case report

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