title: Multimodality therapy of an acquired factor V inhibitor.
abstract: Acquired inhibitors of factor V are rare causes of clinical bleeding, whose severity ranges from mild to life-threatening. Optimal treatment of patients with factor V inhibitors is uncertain. We report on our successful treatment approach in a patient with spontaneous, life-threatening intracranial bleeding caused by a factor V inhibitor. The patient deteriorated after initial treatment with fresh-frozen plasma and platelet transfusions. He was subsequently treated with a combination of plasma exchange and chemotherapy, which led to complete recovery. Our experience suggests that plasma exchange may be life-saving in cases of severe bleeding caused by factor V inhibitors. The use of plasmapheresis in conjunction with chemotherapy is an efficacious and well-tolerated treatment and should be considered in patients with factor V inhibitors.
authors.affiliation: Division of Laboratory Medicine and Hematology, Department of Pathology and Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
authors.forename: Y X
authors.initials: YX
authors.lastname: Fu
authors.forename: R
authors.initials: R
authors.lastname: Kaufman
authors.forename: A E
authors.initials: AE
authors.lastname: Rudolph
authors.forename: S E
authors.initials: SE
authors.lastname: Collum
authors.forename: M A
authors.initials: MA
authors.lastname: Blinder
mesh_terms: D000368:Aged; D001323:Autoantibodies / Q000276:immunology* / Q000302:isolation & purification; D001327:Autoimmune Diseases / Q000150:complications / Q000276:immunology* / Q000628:therapy; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D005165:Factor V / Q000037:antagonists & inhibitors / Q000276:immunology*; D005166:Factor V Deficiency / Q000276:immunology* / Q000628:therapy; D016523:Foot Ulcer / Q000150:complications; D006408:Hematoma, Subdural / Q000276:immunology* / Q000601:surgery; D006470:Hemorrhage / Q000209:etiology / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology* / Q000302:isolation & purification; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D010264:Paraplegia / Q000150:complications; D010949:Plasma; D010951:Plasma Exchange; D010956:Plasmapheresis; D011241:Prednisone / Q000627:therapeutic use; D003668:Pressure Ulcer / Q000150:complications; D014552:Urinary Tract Infections / Q000150:complications; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D001323:Autoantibodies; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D014750:Vincristine; D003520:Cyclophosphamide; D005165:Factor V; D011241:Prednisone