Hypothromboplastinemia associated with a circulating anticoagulant and hemorrhagic diathesis

Abstract

I N 1940 Lozner, Jolliffe and Taylor’ presented the first documented case of a hemorrhagic diathesis associated with a circulating anticoagulant. Hematologically, the most prominent feature of the case was the presence of a prolonged coagulation time. Since that initial report a total of thirteen cases have been described in the literature. Conley2 and Dieter3 each presented a case of prolonged clotting time associated with a circulating anticoagulant arising spontaneously in a non-hemophiliac male. Munro4 and Van Creveld6 reported the phenomenon of the failure of hemophiliac patients to respond to fresh blood or plasma transfusions. All of these patients had responded to previous therapy with a marked reduction in the clotting time. Hewlett and Haden reported two females, seven months and one year postpartum, respectively, with a prolonged coagulation time and a circulating anticoagulant, neither patient having received blood transfusions previously. Dreskin and Rosenthal’ reported a similar experience in a thirty year old female seven weeks postpartum. In all cases the coagulation time was significantly prolonged and an anticoagulant was identified. These cases may be divided into three categories; (1) cases in which the anticoagulant arose de novo; (2) those which occurred in the postpartum state and (3) those which developed in patients who had previously received multiple whole blood transfusions. We are presenting the case of a twenty-seven year old female who, three months postpartum, developed her first manifestations of a bleeding tendency. This subsequently became severe and the patient had a massive gastrointestinal hemorrhage. Hematologic studies revealed a markedly prolonged clotting time associated with the presence of a circulating anticoagulant.