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A Metadata Extraction Approach for Clinical Case Reports to Enable Advanced Understanding of Biomedical Concepts
Published on: September 20, 2018
Acquired Combined Factor Deficiency: Case Report
Background:
Acquired hemophilia is a rare bleeding disorder. Difenacoum (superwarfarin), an antivitamin K anticoagulant, has been commonly used as a rodenticide. Factors II, VII, IX, and X are reduced as a result of this inhibition.
Methods:
In this article, we have presented a case that had been exposed to superwarfarin according to our consideration, but for which factor XII, VIII, XI, V deficiency and presence of inhibitor could not be explained.
Results:
Coagulation tests of the patient who applied for hematuria were prolonged. Factor II, V, VII, VIII, IX, X, XI, XII were low; antinuclear antibody, antiphospholipid antibody IgG, and anti-double stranded DNA antibodies were positive. When questioned, he admitted that they used rat poison in the bakery. In addition to fresh frozen plasma, vitamin K and plasma complex concentrate, factor VIII and factor IX were started. However, sufficient response could not be obtained since there were inhibitors against factor VIII and factor IX. Three sessions of plasmapheresis were performed to clear antibodies and immunosuppressive treatment was started. While coagulation tests were still long, there was no new bleeding and hematuria stopped.
Conclusions:
Immunosuppressive treatment and plasmapheresis may be tried if the replacement of deficient factors is not sufficient in acquired factor deficiency.
Insights
A patient with acquired hemophilia due to superwarfarin (anticoagulant rodenticide) poisoning experienced multiple factor deficiencies. Immunosuppressive treatment and plasmapheresis were effective when factor replacement failed.
Area of Science:
- Hematology
- Toxicology
- Internal Medicine
Background:
- Acquired hemophilia is a rare bleeding disorder.
- Difenacoum, a superwarfarin anticoagulant, is a common rodenticide.
- Inhibition of vitamin K-dependent factors (II, VII, IX, X) is a known effect.
Observation:
- A patient presented with hematuria and prolonged coagulation tests.
- The patient had deficiencies in multiple coagulation factors (II, V, VII, VIII, IX, X, XI, XII).
- Autoantibodies including antinuclear, antiphospholipid, and anti-dsDNA antibodies were detected.
Findings:
- Exposure to difenacoum (superwarfarin) rat poison was confirmed.
- Initial replacement therapy with fresh frozen plasma, vitamin K, and prothrombin complex concentrate was insufficient.
- Inhibitors against factor VIII and factor IX were present, necessitating plasmapheresis and immunosuppressive treatment.
Implications:
- Plasmapheresis and immunosuppressive therapy can be effective for acquired factor deficiency when factor replacement is insufficient.
- This case highlights the potential for superwarfarin poisoning to cause complex coagulopathy.
- Early diagnosis and targeted treatment are crucial for managing rare bleeding disorders.
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