Apparition d'un anticoagulant circulant antifacteur V après intervention chirurgicale

Abstract

A case is reported of an endogenous inhibitor to factor V occurring one month after subtotal gastrectomy and splenectomy, with peroperative radiotherapy, for gastric adenocarcinoma. Preoperative coagulation tests were normal : 31 s for activated kephalin time (control 31 s) and 93 % for prothrombin level. There was a fall in this latter during the first three postoperative days. Four hundred ml plasma without cryoprotein were therefore given, bringing the coagulation tests back to the normal range. On day 25, a routine check showed an activated kephalin time of 71 s (control 31 s), a prothrombin level of 13 % with a thrombin time of 18 s (control 18 s). There was no associated haemorrhagic diathesis. Measurement of all the individual coagulation factors showed that there was a fall in factor V level (0.05 IU · ml −1). A large amount of antifactor V antibody was then found (47 IU · ml −1). No treatment was undertaken, the patient being so well. Two months later, the antibody had disappeared. The usual circumstances in which this antibody can be seen and the management of the related severe haemorrhages are discussed.