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A discrepancy between prothrombin time and Normotest (Hepaplastintest) results is useful for diagnosis of acquired factor V inhibitors

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Abstract

Acquired coagulation factor inhibitors are rare. Among them, coagulation factor V (FV) inhibitor is particularly uncommon and presents with variable clinical manifestations. Certain acquired FV inhibitor patients have only mild bleeding or, in select cases, no symptoms at all, leading to spontaneous recovery. Others have life-threatening bleeding that requires medical attention. Thus, a prompt decision regarding diagnosis and clinical intervention is crucial for such patients. In five acquired FV inhibitor cases treated in our facility, each patient had a malignancy as an underlying disease and all unexpectedly showed prolongation of both prothrombin time (PT) and activated partial thromboplastin time (APTT). They all also displayed a discrepancy between PT and Normotest (Hepaplastintest, HPT) results. All but one patient experienced no bleeding at the time of diagnosis and achieved spontaneous recovery in 1–3 weeks. The patient with bleeding symptoms received plasma exchanges and a platelet transfusion. Useful markers in diagnosing the presence of an acquired FV inhibitor were a sudden prolongation of PT and APTT, and a discrepancy between the PT/APTT and HPT assays. Spontaneous recovery can be expected for patients with only minor bleeding.

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References

  1. Franchini M, Lippi G. Acquired factor V inhibitors: a systematic review. J Thromb Thrombolysis. 2011;314:449–57.

    Article  CAS  Google Scholar 

  2. Wang X, Qin X, Yu Y, Wang R, Liu X, Ji M, et al. Acquired factor V deficiency in a patient with a urinary tract infection presenting with haematuria followed by multiple haemorrhages with an extremely low level of factor V inhibitor: a case report and review of the literature. Blood Coagul Fibrinolysis. 2017;28:334–41.

    Article  PubMed  CAS  Google Scholar 

  3. Tanaka I, Amano K, Taki M, Oka T, Sakai M, Shirahata A, et al. A 3-year consecutive survey on current status of acquired inhibitors against coagulation factors in Japan—analysis of prognostic factors. Jpn J Thromb Hemost. 2008;19:140–53.

    Article  Google Scholar 

  4. Ogawa Y, Yanagisawa K, Uchiumi H, Ishizaki T, Mitsui T, Gouda F, et al. Clinical characteristics and outcomes of acquired hemophilia A: experience at a single center in Japan. Int J Hematol. 2017;106:82–9.

    Article  PubMed  Google Scholar 

  5. Streiff MB, Ness PM. Acquired FV inhibitors: a needless iatrogenic complication of bovine thrombin exposure. Transfusion. 2002;42:18–26.

    Article  PubMed  Google Scholar 

  6. Ang AL, Kuperan P, Ng CH, Ng HJ. Acquired factor V inhibitor. A problem-based systematic review. Thromb Haemost. 2009;101:852–9.

    Article  PubMed  CAS  Google Scholar 

  7. Owren PA, Standi OK. Normotest. Farmakotherapi. 1969;25:14.

    CAS  Google Scholar 

  8. Tsukada H, Shimoda T, Matsuo N, Hiraishi A, Shimoyama C, Arai H, et al. Study on Normotest (Hepaplastin test). Blood Vessel. 1976;7:111–8.

    Article  Google Scholar 

  9. Takeuchi T, Ueno T, Arai H, Maekawa T, Tsukada H. Studies of Normotest (Hepaplastin test) on control of anticoagulant therapy. Blood Vessel. 1977;8:320–5.

    Article  Google Scholar 

  10. Ashizawa M, Kimura S, Wada H, Sakamoto K, Sato M, Terasako K, et al. Acquired factor V inhibitor associated with life-threatening bleeding and a mixing test result that indicated coagulation factor deficiency. Hematology. 2013;18:300–4.

    Article  PubMed  Google Scholar 

  11. Nesheim ME, Nichols WL, Cole TL, Houston JG, Schenk RB, Mann KG, et al. Isolation and study of an acquired inhibitor of human coagulation factor V. J Clin Investig. 1986;77:405–15.

    Article  PubMed  CAS  Google Scholar 

  12. Chediak J, Ashenhurst JB, Garlick I, Desser RK. Successful management of bleeding in a patient with factor V inhibitor by platelet transfusions. Blood. 1980;56:835–41.

    PubMed  CAS  Google Scholar 

  13. Lebrun A, Leroy-Matheron C, Arlet JB, Bartolucci P, Michel M. Successful treatment with rituximab in a patient with an acquired factor V inhibitor. Am J Hematol. 2008;83:163–4.

    Article  PubMed  Google Scholar 

  14. Ma ES, Liang RH, Chu KM, Lau GK. Complete response of acquired FV inhibitor to rituximab. Int J Hematol. 2015;101:421–2.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported in part by research aids from the Japanese Ministry of Health, Labor, and Welfare (to A.I.). We would like to thank all members of the “Japanese Collaborative Research Group (JCRG) on Autoimmune Haemorrhaphilia”.

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Authors and Affiliations

  1. Department of Hematology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan

    Yasuko Kadohira, Shinya Yamada, Tomoe Hayashi, Eriko Morishita & Hidesaku Asakura

  2. Japanese Collaborative Research Group on Autoimmune Haemorrhaphilia Supported by the Japanese Ministry of Health, Labor and Welfare, Yamagata, Japan

    Hidesaku Asakura & Akitada Ichinose

  3. Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School, Yamagata, Japan

    Akitada Ichinose

Authors
  1. Yasuko Kadohira
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  2. Shinya Yamada
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  3. Tomoe Hayashi
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  4. Eriko Morishita
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  5. Hidesaku Asakura
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  6. Akitada Ichinose
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Corresponding author

Correspondence to Yasuko Kadohira.

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The authors declare no conflicts of interest in association with the present study.

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Kadohira, Y., Yamada, S., Hayashi, T. et al. A discrepancy between prothrombin time and Normotest (Hepaplastintest) results is useful for diagnosis of acquired factor V inhibitors. Int J Hematol 108, 145–150 (2018). https://doi.org/10.1007/s12185-018-2453-z

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  • DOI: https://doi.org/10.1007/s12185-018-2453-z

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