Successful use of recombinant factor VIIa for management of severe menorrhagia in an adolescent with an acquired inhibitor of human thrombin.
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.
Giovannini
L
L
Service de Pédiatrie, Hôpital de l'Archet, CHU Nice, France.
Appert
A
A
Monpoux
F
F
Fischer
F
F
Boutte
P
P
Sirvent
N
N
D002648:Child; D015942:Factor VIIa / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008595:Menorrhagia / Q000188:drug therapy* / Q000209:etiology; D013917:Thrombin / Q000037:antagonists & inhibitors*
D015942:Factor VIIa; D013917:Thrombin