title: Acquired inhibitors to coagulation factors in patients with gastrointestinal diseases.
abstract: OBJECTIVE
  To study the frequency and specificity of acquired coagulation inhibitors in inflammatory and malignant gastrointestinal diseases.
  
  
  METHODS
  In a 10-year period, 511 patients from the island of Crete in Greece were studied, 302 with ulcerative colitis, 112 with Crohn's disease, 82 with gastrointestinal carcinoma and 15 with gastrointestinal lymphoma. Prothrombin time and activated partial thromboplastin time were measured by routine methods. When prothrombin time and/or activated partial thromboplastin time were found to be prolonged, mixture experiments with 25%, 50% and 75% pooled normal human plasma were performed. If clotting times were inadequately corrected, the presence of an acquired inhibitor against a coagulation factor was suggested. Specific coagulation factor assays were then performed with deficient plasmas.
  
  
  RESULTS
  Fifteen patients acquired inhibitors to the following coagulation factors within the 10-year observation period: factor IX (four patients); factor X (three patients); factor XII (three patients); factor VIII (two patients); factor XI (two patients); and factor V (one patient). The activity of the above factors varied from < 1% to 10%. Five patients with ulcerative colitis, six with Crohn's disease, two with gastrointestinal lymphoma and two with gastrointestinal carcinoma developed an inhibitor. Only one patient with factor VIII inhibitor presented with severe bleeding and was treated with recombinant human activated factor VII, while the others had no complications. Remission was obtained in all patients after immunosuppressive therapy, chemotherapy or tumour resection.
  
  
  CONCLUSIONS
  An increased incidence of coagulation factor inhibitors was found in patients with gastrointestinal inflammatory and malignant diseases compared to the healthy population. In addition, an increased incidence of these inhibitors was also found in the common population of Crete compared to that found in other areas.
authors.affiliation: Department of Haematology, University Hospital of Heraklion, Crete, Greece.
authors.forename: Despina S
authors.initials: DS
authors.lastname: Kyriakou
authors.forename: Michael G
authors.initials: MG
authors.lastname: Alexandrakis
authors.forename: Freda H
authors.initials: FH
authors.lastname: Passam
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Foundouli
authors.forename: Emmanouel
authors.initials: E
authors.lastname: Matalliotakis
authors.forename: Ioannis E
authors.initials: IE
authors.lastname: Koutroubakis
authors.forename: Taxiarchis V
authors.initials: TV
authors.lastname: Kourelis
authors.forename: George
authors.initials: G
authors.lastname: Chalkiadakis
authors.forename: Orestis N
authors.initials: ON
authors.lastname: Manoussos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001779:Blood Coagulation Factors / Q000037:antagonists & inhibitors*; D003093:Colitis, Ulcerative / Q000097:blood*; D003424:Crohn Disease / Q000097:blood*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000097:blood*; D006474:Hemorrhagic Disorders / Q000097:blood / Q000209:etiology; D006801:Humans; D008223:Lymphoma / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011517:Prothrombin Time
chemical_list: D001779:Blood Coagulation Factors