Factor V antibody and disseminated intravascular coagulation

Area of Science:

• Hematology
• Immunology
• Clinical Medicine

Background:

• Acquired factor V inhibitors are rare but can cause serious bleeding complications.
• Post-operative complications, including thrombosis and bleeding, necessitate thorough investigation of underlying hemostatic abnormalities.

Observation:

• A 79-year-old male developed a factor V inhibitor within one month of surgery for a fractured leg.
• Immunoglobulin analysis revealed the inhibitor's activity was primarily IgG, with a notable IgA component.
• The patient experienced septicemia and disseminated intravascular coagulation (DIC) while factor V activity was undetectable.

Findings:

• This case represents the first documented instance of an IgA immunoglobulin exhibiting factor V inhibitory activity.
• The coexistence of a factor V inhibitor and DIC, despite absent circulating factor V, presents an unexplained pathophysiological mechanism.
• The factor V inhibitor spontaneously resolved within five months of its initial detection.

Implications:

• The identification of IgA as a potential factor V inhibitor broadens our understanding of autoimmune hematological disorders.
• Further research is needed to elucidate the mechanism linking factor V inhibitors to DIC in the absence of detectable factor V.
• This case highlights the importance of considering rare inhibitor profiles in patients presenting with unexplained coagulopathies post-surgery.