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Published on: September 9, 2012
Acquired coagulation factor inhibitors in children after topical bovine thrombin exposure
William J Savage1, Thomas S Kickler, Clifford M Takemoto
1Division of Pediatric Hematology, The Johns Hopkins University, Baltimore, Maryland 21205, USA.
Insights
Bovine thrombin can trigger acquired inhibitors of coagulation factors like factor V (FV) in children, leading to bleeding complications. Early recognition and management are crucial for pediatric patients exposed to topical bovine thrombin.
Area of Science:
- Pediatric Hematology
- Immunology
- Surgical Hemostasis
Background:
- Topical bovine thrombin is frequently used for hemostasis in pediatric surgeries.
- Acquired inhibitors to coagulation factors, particularly factor V (FV) and thrombin, can arise post-exposure.
- Clinically significant coagulopathies may result from these acquired inhibitors.
Observation:
- Two pediatric cases of acquired FV and/or thrombin inhibitors following bovine thrombin exposure during cardiac surgery are presented.
- One patient developed a FV inhibitor at 3 months, resolving with IVIG and steroids.
- Another patient developed concurrent FV and thrombin inhibitors at 11 years, complicating anticoagulation but resolving transiently.
Findings:
- Review of literature identified additional pediatric cases of bovine thrombin-induced inhibitors.
- Bovine thrombin demonstrates antigenicity in infants and children.
- These inhibitors can precipitate significant coagulopathies in pediatric populations.
Implications:
- Highlights the potential for bovine thrombin to induce immune responses in pediatric patients.
- Underscores the need for vigilance regarding coagulopathy development after bovine thrombin use in children.
- Suggests potential therapeutic strategies for managing these rare but serious complications.
Abstract:
Acquired inhibitors of coagulation factors, particularly to factor V (FV) and thrombin, after topical bovine thrombin exposure may result in clinically important coagulopathies. While bovine thrombin is commonly used in pediatric patients for surgical hemostasis, the reported cases of acquired inhibitors in children are few. We report two cases of children who developed factor inhibitors after bovine thrombin exposure. One child developed a FV inhibitor at 3 months of age after exposure to bovine thrombin during cardiac surgery. The inhibitor resolved with intravenous immunoglobulin (IVIG) and steroids. The other child developed concomitant FV and bovine thrombin inhibitors after cardiac surgery at age 11 years. The presence of these inhibitors complicated post-operative anti-coagulation management, but the inhibitors were transient. In addition to these two cases, we identified all the pediatric patients with bovine thrombin-induced inhibitors who were reported in the world's literature, and reviewed their clinical characteristics. These cases underscore the fact that bovine thrombin can be antigenic in infants and children and can result in significant coagulopathies.
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