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A high titer of acquired factor V inhibitor in a hemodialysis patient who developed arterial thrombosis

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Abstract

An 87-year-old man with diabetes mellitus was admitted to control recurrent bleeding from hemodialysis puncture sites. He was a smoker and had been diagnosed with arteriosclerosis obliterans. His PT and APTT were markedly prolonged, and all coagulation factors were markedly decreased (factor V [FV] activity < 1%) or below the measurement threshold, with the exception of fibrinogen and factor XIII. Neither PT nor APTT were corrected upon mixing with normal plasma. A high titer of FV inhibitor was found at 415 BU/mL, and anti-FV autoantibody was detected by both immunoblot assay and ELISA. Prednisolone administration and plasma exchange partially improved prolonged PT and APTT and decreased the FV inhibitor level. Five months later, he manifested symptoms of severe ischemia in both legs. Angiography revealed diffuse stenosis downstream of both common iliac arteries. Endovascular therapy was repeated four times, the prednisolone dose was reduced, and low-dose antiplatelet therapy was initiated. After the final successful endovascular therapy, arterial thrombosis was detected using ultrasound and angiography. Aspiration thrombectomy and thrombolytic therapy failed to achieve recanalization, and necrosis of the legs worsened. Despite the severe coagulation abnormalities, vascular interventions should have been performed with regular-dose antiplatelet therapy, as the patient exhibited multiple risk factors for atherothrombosis.

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Acknowledgements

This study was supported in part by research aids from the Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT), the Japanese Ministry of Health, Labor and Welfare (MHLW), and a research gran from Japan Agency for Medical Research and Development (AMED). We would like to thank all members of ‘Japanese Collaborative Research Group (JCRG) on Autoimmune Coagulation Factor Deficiencies’ and Ms. Yuriko Shibue and Ms. Eiko Ichinose for their cooperation in conducting a nation-wide survey in Japan from 2009 to 2018.

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Author notes

  1. Masayoshi Souri & Tsukasa Osaki

    Present address: Department of Public Health, Yamagata University School of Medicine, Yamagata, Japan

Authors and Affiliations

  1. Department of Nephrology, Ohkubo Hospital, Tokyo, Japan

    Hina Ogawa, Rie Ohkubo, Tomoko Kawanishi & Sachiko Wakai

  2. Japanese Collaborative Research Group on Autoimmune Coagulation Factor Deficiencies (JCRG supported by the Japanese Ministry of Health, Labor and Welfare), Yamagata, Japan

    Masayoshi Souri, Kazunori Kanouchi, Tsukasa Osaki, Keita Morikane & Akitada Ichinose

  3. Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan

    Masayoshi Souri, Tsukasa Osaki & Akitada Ichinose

  4. Department of Clinical Laboratory Medicine, Yamagata University School of Medicine, Yamagata, Japan

    Kazunori Kanouchi & Keita Morikane

Authors
  1. Hina Ogawa
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  2. Masayoshi Souri
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  3. Kazunori Kanouchi
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  4. Tsukasa Osaki
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  5. Rie Ohkubo
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  6. Tomoko Kawanishi
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  7. Sachiko Wakai
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  8. Keita Morikane
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  9. Akitada Ichinose
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Contributions

HO carried out clinical studies and drafted the manuscript, MS, KK and TO performed experimental laboratory examinations and analyzed the results, SO, TK, and SW collected clinical data, KM reviewed the project and the manuscript, and AI designed the project and experiments, analyzed the results and wrote the manuscript. All authors have approved the submitted version.

Corresponding author

Correspondence to Akitada Ichinose.

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The authors declare no conflicts of interests in association with this study.

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Ogawa, H., Souri, M., Kanouchi, K. et al. A high titer of acquired factor V inhibitor in a hemodialysis patient who developed arterial thrombosis. Int J Hematol 109, 214–220 (2019). https://doi.org/10.1007/s12185-018-2561-9

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  • DOI: https://doi.org/10.1007/s12185-018-2561-9

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