Acquired Combined Factor Deficiency: Case Report

Abstract

Acquired hemophilia is a rare bleeding disorder. Difenacoum (superwarfarin), an antivitamin K anticoagulant, has been commonly used as a rodenticide. Factors II, VII, IX, and X are reduced as a result of this inhibition. In this article, we have presented a case that had been exposed to superwarfarin according to our consideration, but for which factor XII, VIII, XI, V deficiency and presence of inhibitor could not be explained. Coagulation tests of the patient who applied for hematuria were prolonged. Factor II, V, VII, VIII, IX, X, XI, XII were low; antinuclear antibody, antiphospholipid antibody IgG, and anti-double stranded DNA antibodies were positive. When questioned, he admitted that they used rat poison in the bakery. In addition to fresh frozen plasma, vitamin K and plasma complex concentrate, factor VIII and factor IX were started. However, sufficient response could not be obtained since there were inhibitors against factor VIII and factor IX. Three sessions of plasmapheresis were performed to clear antibodies and immunosuppressive treatment was started. While coagulation tests were still long, there was no new bleeding and hematuria stopped. Immunosuppressive treatment and plasmapheresis may be tried if the replacement of deficient factors is not sufficient in acquired factor deficiency.