Document Detail

Life-threatening bleeding in a patient with a lupus inhibitor and probable acquired factor VII deficiency.
MedLine Citation:
PMID:  17102654     Owner:  NLM     Status:  MEDLINE    
We report the case of a 71-year-old man on warfarin for chronic atrial fibrillation presenting with a massive spontaneous soft tissue bleed. Despite reversing the effects of warfarin with large doses of intravenous vitamin K and fresh frozen plasma, bleeding continued, and his prothrombin time and activated partial thromboplastin time remained prolonged. The prothrombin time and activated partial thromboplastin time failed to correct with 50% normal plasma. Further investigations confirmed a lupus inhibitor with low levels of factors II, V, VII and XI. Factor II, V and XI levels normalized, however, when the patient's plasma was diluted 1:16 in buffer, suggesting the lupus inhibitor may have been interfering with these factor assays causing artefactual low results. Factor VII levels remained consistently low at all dilutions. The patient subsequently died following a massive left haemothorax despite surgical intervention and treatment with activated recombinant factor VII concentrate. We presumed the primary problem was bleeding from a local vascular lesion but the patient was never well enough to undergo confirmatory angiography. This case highlights the fact that patients with lupus inhibitors can develop severe haemorrhagic complications, and illustrates the complexities involved in both the investigation and treatment of abnormal bleeding in these patients.
Sean Lim; Ros Zuha; Tracy Burt; Joseph Chacko; Richard Scott; C Jason Mainwaring
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis     Volume:  17     ISSN:  0957-5235     ISO Abbreviation:  Blood Coagul. Fibrinolysis     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-11-14     Completed Date:  2007-02-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9102551     Medline TA:  Blood Coagul Fibrinolysis     Country:  England    
Other Details:
Languages:  eng     Pagination:  667-71     Citation Subset:  IM    
Department of Haematology, Royal Bournemouth Hospital, Bournemouth, UK.
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MeSH Terms
Anticoagulants / adverse effects*
Atrial Fibrillation / drug therapy
Contusions / blood
Factor VII Deficiency / physiopathology*
Fatal Outcome
Hemorrhage / blood*
Lupus Coagulation Inhibitor / physiology*
Partial Thromboplastin Time
Prothrombin Time
Warfarin / adverse effects*
Reg. No./Substance:
0/Anticoagulants; 0/Lupus Coagulation Inhibitor; 81-81-2/Warfarin

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

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