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Presurgical plasma exchange for severe factor V deficiency
B W Baron1, R Mittendorf, J M Baron
1Department of Pathology (Blood Bank), The University of Chicago, Chicago, Illinois, USA. bbaron@uchospitals.edu
Journal of Clinical Apheresis
|April 20, 2001
Summary
Plasma exchange effectively corrected severe congenital factor V deficiency for surgery. This method rapidly increased factor V levels and may transiently reduce inhibitors, ensuring hemostasis with enhanced safety using solvent/detergent treated plasma.
Area of Science:
- Hematology
- Coagulation Disorders
- Transfusion Medicine
Background:
- Severe congenital factor V deficiency presents a significant challenge for perioperative hemostasis.
- Factor V inhibitors complicate management, requiring specialized treatment strategies.
Observation:
- Two patients with severe congenital factor V deficiency, one with a factor V inhibitor, required urgent coagulopathy correction for surgery.
- Plasma exchange (PE) was utilized with fresh frozen plasma or solvent/detergent treated plasma (S/DP).
Findings:
- PE successfully achieved factor V levels adequate for surgical hemostasis in both patients.
- PE provided rapid factor level correction without causing volume overload.
- Transient reduction in inhibitor titers was observed, potentially improving perioperative factor correction.
Implications:
- Plasma exchange is a viable and effective strategy for managing severe factor V deficiency and inhibitors perioperatively.
- The use of S/DP in PE offers an additional safety margin by reducing the risk of transfusion-transmitted infections.
- These findings support the use of PE as a critical intervention in patients with complex coagulation factor deficiencies requiring surgical intervention.