Fatal hemorrhage due to a spontaneous factor V inhibitor with lupus anticoagulant properties.
: Factor V inhibitors are rare and have varied clinical presentations. We report on a 76-year-old female admitted to the hospital for pneumonia and treated with multiple antibiotics. Her baseline prothrombin time was 15.6 s and the activated partial thromboplastin time was 35 s. On admission day 10, she developed arm weakness and brain imaging showed a subdural hematoma. The prothrombin time was now 59.1 s with an activated partial thromboplastin time of more than 160 s and a normal thrombin time. A mixing study did not correct the clotting times and coagulation factor assays showed a nonspecific inhibition pattern. Only factor V activity remained low with serial dilutions, however, and a 70 Bethesda Unit inhibitor was identified. Aggressive supportive care was initiated but the patient succumbed to the effects of the intracranial hemorrhage. Factor V inhibitors may display lupus anticoagulant properties and may cause catastrophic bleeding. Our case illustrates that these inhibitors can arise quickly and supports an association with antibiotics.
aDepartment of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon bGeisel School of Medicine at Dartmouth, Hanover cDepartment of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Nicholas J
NJ
Olson
Donna
D
Robert
Amin A
AA
Hedayat
Xiaoying
X
Liu
Deborah L
DL
Ornstein
D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects; D001780:Blood Coagulation Tests; D005165:Factor V / Q000037:antagonists & inhibitors* / Q000378:metabolism; D005260:Female; D006408:Hematoma, Subdural / Q000097:blood / Q000150:complications / Q000378:metabolism; D006801:Humans; D020300:Intracranial Hemorrhages / Q000097:blood* / Q000150:complications* / Q000378:metabolism; D016682:Lupus Coagulation Inhibitor / Q000097:blood* / Q000378:metabolism; D011014:Pneumonia / Q000097:blood / Q000150:complications* / Q000188:drug therapy* / Q000378:metabolism
D000900:Anti-Bacterial Agents; D016682:Lupus Coagulation Inhibitor; D005165:Factor V