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Updated: Jun 2, 2025
Measurement of Factor V Activity in Human Plasma Using a Microplate Coagulation Assay
Published on: September 9, 2012
Acquired factor V inhibitor in a case of pediatric venous thrombosis
Sweta Gupta1, Matthew W Bunce2, Emily A Cid2
1Department of Pediatric Hematology, Innovative Hematology, Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, USA.
Insights
Acquired Factor V Inhibitor (AFVwI) is rare, but this case shows successful anticoagulation management for pediatric deep venous thrombosis. The inhibitor became undetectable after treatment.
Area of Science:
- Hematology
- Pediatric Thrombosis
- Autoimmune Disorders
Background:
- Acquired Factor V Inhibitor (AFVwI) is a rare condition.
- It typically causes bleeding, but thrombosis can occur, especially in adults.
Observation:
- A 13-year-old female with Crohn's Disease and May-Thurner anatomy presented with extensive deep venous thrombosis.
- Acquired Factor V Inhibitor (AFVwI) was discovered during workup for prolonged prothrombin time and low Factor V activity.
Findings:
- The pediatric patient with deep venous thrombosis and AFVwI was successfully treated with anticoagulation.
- Low-molecular-weight heparin followed by rivaroxaban was administered without complications.
- AFVwI became undetectable within 5 months, with normalized FV activity.
Implications:
- This is the first reported pediatric case of thrombosis associated with AFVwI.
- Anticoagulation therapy can be effective in managing pediatric thrombosis in the presence of AFVwI.
- Complete resolution of AFVwI and normalization of FV activity are achievable.
Background:
The development of acquired factor (F)V with inhibitor (AFVwI) is rare, resulting mainly in bleeding complications, although sporadic cases of thrombosis in adults have been reported.
Key Clinical Question:
How do you diagnose and manage a pediatric case of acute deep venous thrombosis associated with the concurrent finding of AFVwI?
Clinical Approach:
A 13-year-old female with Crohn's Disease and May-Thurner anatomy developed extensive deep venous thrombosis of the left lower extremity, complicated by the finding of AFVwI, discovered during the evaluation of a prolonged prothrombin time and a low FV activity. Anticoagulation was initiated with low-molecular-weight heparin followed by a direct oral anticoagulant, rivaroxaban, without any complications. AFVwI was undetectable after 5 months with normalization of FV activity.
Conclusion:
Our case highlights the first pediatric case of thrombosis with a rare finding of AFVwI, successfully managed with anticoagulation therapy with complete resolution.
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