Treatment of acquired factor X inhibitor by plasma exchange with concomitant intravenous immunoglobulin and corticosteroids.
A patient with spontaneous hemorrhage from multiple body sites was found to have markedly prolonged international normalized ratio (INR) and activated partial thromboplastin times (aPTT) with incomplete correction of aPTT on mixing studies using normal plasma. The cause of this severe hemorrhage was due to a specific factor X inhibitor. No underlying or associated diseases were found. Initial treatment with fresh frozen plasma, vitamin K, and recombinant activated factor VII (rFVIIa) was unsuccessful. However, therapy utilizing plasma exchange with concomitant intravenous immunoglobulin and corticosteroids resulted in a rapid and sustained normalization of factor X levels with a clinical hemostatic response.
Hsia
Cyrus C
CC
Division of Hematology, Department of Medicine, University of Western Ontario and London Health Sciences Centre, London, Ontario, Canada.
Keeney
Mike
M
Bosco
Annmarie A
AA
Xenocostas
Anargyros
A
D002283:Carcinoma, Bronchogenic / Q000150:complications / Q000601:surgery; D003131:Combined Modality Therapy; D005170:Factor X / Q000037:antagonists & inhibitors* / Q000276:immunology; D005171:Factor X Deficiency / Q000209:etiology / Q000276:immunology / Q000628:therapy*; D006474:Hemorrhagic Disorders / Q000209:etiology*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008175:Lung Neoplasms / Q000150:complications / Q000601:surgery; D008206:Lymphatic Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use*; D014777:Virus Diseases / Q000150:complications
D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D005170:Factor X; D011241:Prednisone