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[A case positive for the inhibitor for coagulation factor V]
R Nakagoshi1, O Takamiya, S Nakata
1Division of Clinical Pathology, Nagano Children's Hospital, Toyoshina.
Rinsho Byori. the Japanese Journal of Clinical Pathology
|December 11, 1999
Summary
A patient with liver cancer developed an inhibitor for coagulation Factor V (FV). This rare autoimmune condition, likely triggered by human thrombin exposure, significantly impaired blood clotting.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Hepatocellular carcinoma (HCC) is a primary liver cancer.
- Coagulation factor inhibitors are rare but can cause significant bleeding complications.
- Factor V (FV) inhibitors are particularly uncommon.
Observation:
- A 71-year-old male with HCC presented with markedly prolonged prothrombin time and activated partial thromboplastin time.
- Coagulation screening revealed severely reduced FV activity (<1%) and high levels of FV-specific inhibitory activity (32 Bethesda units).
- The inhibitory activity was identified as an immunoglobulin G (IgG) antibody against FV.
Findings:
- The patient had a history of receiving human thrombin preparations for bleeding management.
- Previous reports link bovine thrombin exposure to FV inhibitor development.
- These findings suggest a potential link between human thrombin exposure and the development of FV inhibitors.
Implications:
- This case highlights a potential, previously unreported, cause of acquired Factor V inhibitors.
- It underscores the importance of considering iatrogenic triggers for rare autoimmune conditions.
- Further research is warranted to investigate the immunogenicity of human thrombin preparations.