Abstract
Development of acquired factor V (FV) inhibitor is a rare coagulation disorder. Production of heteroantibodies against bovine FV, a contaminant in fibrin tissue adhesives, is a common cause of this condition in the field of surgery. The development of recombinant thrombin eliminated contamination of bovine FV, and infrequent use of bovine thrombin has decreased the risk of FV inhibitor development. Here, we report the case of a 43-year-old man who had marked prolongation of prothrombin time and activated partial thromboplastin time after surgery. Mixing coagulation studies with normal plasma and patient’s plasma suggested the presence of an inhibitor. Clotting factor assays revealed that FV activity decreased to <1% with positive FV inhibitor titer (9.2 Bethesda units). The diagnosis of the FV inhibitor was confirmed. Overt bleeding was not observed during the course of hospitalization. His coagulation abnormalities rapidly normalized without any medical intervention. A careful review of his medical records revealed that no tissue adhesives were used in the patient, and the FV inhibitor would likely be autoantibodies. Antibiotic use during the perioperative period or the surgical procedure itself may trigger the occurrence of FV inhibitors. This case highlights that FV inhibitor may develop after the surgical procedure even without a history of the use of fibrin tissue adhesives. Surgeons and hematologists should be aware that this rare but potentially life-threatening condition may occur after the surgical procedure.
Highlights
Development of acquired coagulation factor inhibitors is a rare postoperative complication
Heteroantibodies developed against bovine factors V (FV), a contaminant in bovine thrombin preparations used as surgical fibrin tissue adhesives, crossreact and neutralize human FV [2]
As the development of recombinant thrombin eliminated the contamination of bovine FV, the FV inhibitor associated with tissue adhesives has been infrequently reported
Summary
Development of acquired coagulation factor inhibitors is a rare postoperative complication. We report a case of an FV inhibitor that developed after surgery in a male patient who had marked prolongation in coagulation time, no tissue adhesives had been used. On POD 10, hemostatic tests revealed marked prolongation of PT (PT-INR 7.18) and APTT (>150 seconds), the D-dimer level decreased to 1.8 mg/L. Based on the clinical course and laboratory findings, antiphospholipid syndrome (APS) or acquired coagulation factor inhibitors were suspected. The APTT crossmixing test revealed a convex upward curve (Figure 1), suggesting the presence of inhibitors, including lupus anticoagulants or coagulation factor-neutralizing antibodies [3]. On POD 45, both PT and APTT were within the normal range (PT-INR 1.01 and 28.0 seconds, respectively). Because there was no bleeding tendency, the patient was observed without any immunosuppressant or platelet transfusion
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