Development of antibodies to human thrombin and factor V in a pediatric patient exposed to topical bovine thrombin.
Bovine topical thrombin is commonly used for local hemostasis in pediatric surgery. Acquired inhibitors to coagulation factors, particularly to factor V and bovine thrombin, have been infrequently reported in the pediatric population. We report a 3-year-old male who developed a coagulopathy and clinical bleeding after cardiothoracic surgery, during which bovine topical thrombin was used for local hemostasis. Laboratory tests revealed elevated prothrombin, partial thromboplastin, and thrombin times, and a low factor V activity level. He was found to have both human-thrombin and factor V inhibitors, among the first reported cases of these combined inhibitors secondary to bovine topical thrombin. He was treated with intravenous immunoglobulin and steroids with a rapid and durable response.
Lo
Clara Y
CY
Department of Pediatric, Stanford University, Stanford, California, USA.
Jones
Carol
C
Glader
Bertil
B
Zehnder
James L
JL
D000287:Administration, Topical; D000818:Animals; D001778:Blood Coagulation Disorders / Q000276:immunology / Q000628:therapy; D001779:Blood Coagulation Factors / Q000378:metabolism; D002417:Cattle; D002675:Child, Preschool; D005165:Factor V / Q000037:antagonists & inhibitors* / Q000276:immunology*; D006470:Hemorrhage / Q000276:immunology / Q000628:therapy; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis / Q000276:immunology*; D016756:Immunoglobulins, Intravenous; D008297:Male; D011379:Prognosis; D011517:Prothrombin Time; D013917:Thrombin / Q000008:administration & dosage / Q000037:antagonists & inhibitors* / Q000276:immunology*; D013918:Thrombin Time; D013925:Thromboplastin / Q000378:metabolism
D001779:Blood Coagulation Factors; D007074:Immunoglobulin G; D016756:Immunoglobulins, Intravenous; D005165:Factor V; D013925:Thromboplastin; D013917:Thrombin