Document Detail

Acquired bleeding disorder in a patient with malignant lymphoma: antibody-mediated prothrombin deficiency.
MedLine Citation:
PMID:  11241228     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Bleeding manifestations secondary to acquired hemostatic abnormalities in cancer patients have been well described. Bleeding due to the development of hemostatic inhibitors is observed less frequently. In this report, the authors describe a patient with a low grade lymphoma who presented with an acquired bleeding disorder and abnormal hemostatic screening tests. METHODS: Patient plasma samples were collected initially and during the course of treatment. Mixing studies and specific coagulation factor assays were performed to detect and confirm any deficiencies. Patient immunoglobulin G was isolated from plasma, and binding to prothrombin was demonstrated by immunoblot method and enzyme-linked immunosorbent assay (ELISA) techniques. RESULTS: Initial prolongations in the prothombin time and the activated partial thromboplastin time suggested a factor deficiency in the common pathway of coagulation. Factor assays confirmed that the coagulation abnormality in this patient was the result of an acquired prothrombin (factor II) deficiency. This was confirmed by an immunoassay for prothrombin antigen. Further studies demonstrated the presence of a noninhibitory antibody to prothrombin that interacted with a calcium dependent epitope. CONCLUSIONS: Successful treatment of the lymphoma resulted in clearance of the antibody and complete correction of all hemostatic abnormalities and manifestations. An acquired prothrombin deficiency has not been reported previously in association with a malignancy, and this patient represents the first such documented case.
E S Lee; B K Hibsman; H A Liebman
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Cancer     Volume:  91     ISSN:  0008-543X     ISO Abbreviation:  Cancer     Publication Date:  2001 Feb 
Date Detail:
Created Date:  2001-03-12     Completed Date:  2001-04-19     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0374236     Medline TA:  Cancer     Country:  United States    
Other Details:
Languages:  eng     Pagination:  636-41     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2001 American Cancer Society.
Division of Hematology, Department of Medicine, University of Southern California School of Medicine, Los Angeles, California, USA.
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MeSH Terms
Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Autoantibodies / immunology*
Enzyme-Linked Immunosorbent Assay
Hypoprothrombinemias / complications*,  diagnosis,  immunology
Immunoglobulin G / immunology
Lymphoma, Non-Hodgkin / complications*,  diagnosis,  drug therapy
Middle Aged
Prothrombin / immunology*
Reg. No./Substance:
0/Autoantibodies; 0/Immunoglobulin G; 9001-26-7/Prothrombin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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