title: Successful use of recombinant factor VIIa for management of severe menorrhagia in an adolescent with an acquired inhibitor of human thrombin.
abstract: Antibodies directed against human thrombin are exceedingly rare, having only been reported in adult patients with underlying diseases. Consensus on the most appropriate management has not yet been reached. A 12-y-old girl presented with intractable menorrhagia several days after an acute infectious episode. Laboratory tests revealed disturbed clotting tests: prothrombin index 17%, activated partial thromboplastin time >150 s, thrombin time >120 s, and failure to achieve correction with a normal pooled plasma. Further studies demonstrated the presence of an antibody directed against human thrombin. Viral serology revealed a 1/128 titre for adenovirus. Massive haemorrhage was unresponsive to standard treatments, but intravenous administration of recombinant factor VIIa resulted in a successful outcome.
  
  
  CONCLUSIONS
  This is the first report of an anti-human thrombin antibody associated with severe bleeding in a child. Recombinant factor VIIa could represent a novel therapeutic approach for such patients.
authors.affiliation: Service de Pédiatrie, Hôpital de l'Archet, CHU Nice, France.
authors.forename: L
authors.initials: L
authors.lastname: Giovannini
authors.forename: A
authors.initials: A
authors.lastname: Appert
authors.forename: F
authors.initials: F
authors.lastname: Monpoux
authors.forename: F
authors.initials: F
authors.lastname: Fischer
authors.forename: P
authors.initials: P
authors.lastname: Boutte
authors.forename: N
authors.initials: N
authors.lastname: Sirvent
mesh_terms: D002648:Child; D015942:Factor VIIa / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008595:Menorrhagia / Q000188:drug therapy* / Q000209:etiology; D013917:Thrombin / Q000037:antagonists & inhibitors*
chemical_list: D015942:Factor VIIa; D013917:Thrombin