IgM anticoagulant with acquired abnormalities in factor VIII.
The effects of an IgM lupus anticoagulant on coagulation tests and factor VIII related antigen (FVIIR:Ag) were investigated on a 62 year old man with lymphocytic lymphoma. He experienced no abnormal bleeding despite a prothrombin time of 29 seconds, PTT 84 seconds and inhibition of multiple coagulation factors. One course of chemotherapy induced a clinical response, normalization of coagulation studies and a rapid fall in IgM from 1120 to less than 30 mg%. Studies revealed a monoclonal IgM, immediate-acting lupus anticoagulant. This IgM could not be shown to affect normal FVIIIR:Ag but the patient's FVIIIR:Ag was grossly abnormal on crossed immunoelectrophoresis with a normal and a rapidly-migrating peak. The anodal component disappeared after chemotherapy. These studies suggest that the anticoagulant was temporally related to but did not cause the abnormality in FVIIIR:Ag. Such antibodies may occasionally serve as disease markers and may point out the disparity between coagulation tests and hemostasis.
D000941:Antigens / Q000032:analysis*; D001778:Blood Coagulation Disorders / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D001779:Blood Coagulation Factors / Q000032:analysis / Q000037:antagonists & inhibitors*; D005164:Factor IX / Q000032:analysis; D005169:Factor VIII / Q000032:analysis / Q000276:immunology*; D005172:Factor XI / Q000032:analysis; D006801:Humans; D007123:Immunoelectrophoresis, Two-Dimensional; D007075:Immunoglobulin M; D016682:Lupus Coagulation Inhibitor; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010974:Platelet Aggregation / Q000187:drug effects; D014841:von Willebrand Factor
D000941:Antigens; D001779:Blood Coagulation Factors; D007075:Immunoglobulin M; D016682:Lupus Coagulation Inhibitor; D014841:von Willebrand Factor; D005169:Factor VIII; D005164:Factor IX; D005172:Factor XI