title: Acquired coagulation factor inhibitors in children after topical bovine thrombin exposure.
abstract: Acquired inhibitors of coagulation factors, particularly to factor V (FV) and thrombin, after topical bovine thrombin exposure may result in clinically important coagulopathies. While bovine thrombin is commonly used in pediatric patients for surgical hemostasis, the reported cases of acquired inhibitors in children are few. We report two cases of children who developed factor inhibitors after bovine thrombin exposure. One child developed a FV inhibitor at 3 months of age after exposure to bovine thrombin during cardiac surgery. The inhibitor resolved with intravenous immunoglobulin (IVIG) and steroids. The other child developed concomitant FV and bovine thrombin inhibitors after cardiac surgery at age 11 years. The presence of these inhibitors complicated post-operative anti-coagulation management, but the inhibitors were transient. In addition to these two cases, we identified all the pediatric patients with bovine thrombin-induced inhibitors who were reported in the world's literature, and reviewed their clinical characteristics. These cases underscore the fact that bovine thrombin can be antigenic in infants and children and can result in significant coagulopathies.
authors.affiliation: Division of Pediatric Hematology, The Johns Hopkins University, Baltimore, Maryland 21205, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Savage
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Kickler
authors.forename: Clifford M
authors.initials: CM
authors.lastname: Takemoto
mesh_terms: D000287:Administration, Topical; D000818:Animals; D019774:Blood Coagulation Factor Inhibitors / Q000037:antagonists & inhibitors / Q000276:immunology*; D006348:Cardiac Surgical Procedures / Q000379:methods; D002417:Cattle; D002648:Child; D005165:Factor V / Q000037:antagonists & inhibitors / Q000276:immunology; D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage / Q000494:pharmacology; D007223:Infant; D007275:Injections, Intravenous; D008297:Male; D013256:Steroids / Q000008:administration & dosage / Q000494:pharmacology; D013917:Thrombin / Q000008:administration & dosage* / Q000009:adverse effects* / Q000276:immunology; D018785:Tricuspid Atresia / Q000188:drug therapy / Q000276:immunology / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000379:methods
chemical_list: D019774:Blood Coagulation Factor Inhibitors; D007136:Immunoglobulins; D013256:Steroids; D005165:Factor V; D013917:Thrombin