ro13-9904 and Hemorrhagic-Disorders

Factor XIII (FXIII) is a fibrin-stabilizing factor consisting of catalytic A subunits (FXIII-A) and carrier B subunits (FXIII-B). Congenital FXIII deficiency is a rare bleeding disorder. Acquired FXIII deficiency resulting from FXIII hypo-synthesis and/or hyperconsumption is a relatively common disorder in which patients seldom bleed. On the contrary, 'autoimmune/acquired hemorrhaphilia XIII/13 due to anti-FXIII antibodies (AH13)' is a rare but life-threatening bleeding disorder. Through a nationwide survey of AH13, we diagnosed aggressive AH13 in a 66-year-old woman. She consulted our department because of a spontaneous hematoma in her hand. After 1.5 months, she also developed an intramuscular hematoma but retained approximately half (52%) of the normal FXIII activities. The patient's bleeding symptoms were aggravated to catastrophic massive bleedings in the large abdominal muscles and intrapelvic and intraperitoneal spaces. Two months after the bleeding onset, she died despite undergoing plasma exchange, which was performed because we were deeply suspicious of the presence of an anti-FXIII inhibitor. Seven days after her death, extremely low FXIII activity (6%) and positive data on anti-FXIII inhibitor were reported by a commercial laboratory. Our dot blot assay detected anti-FXIII-A autoantibodies, afterwards. Thus, the diagnosis of aggressive AH13 as early as possible is necessary to save patients' lives.

Topics: Aged; Anti-Bacterial Agents; Autoantibodies; Autoimmune Diseases; Ceftriaxone; Delayed Diagnosis; Disease Progression; Epistaxis; Factor XIII; Factor XIII Deficiency; Fatal Outcome; Female; Gingival Hemorrhage; Hematoma; Hemodiafiltration; Hemoperitoneum; Hemorrhagic Disorders; Humans; Neurosyphilis; Partial Thromboplastin Time; Plasma Exchange

An 84-year-old woman under warfarin therapy, who had undergone mechanical valve replacement 29 months previously, developed coagulation abnormalities after antibiotic treatment for pyelonephritis. Laboratory findings included PT at 47.6 sec, activated thromboplastin time (APTT) at 147 sec, factor V (FV) activity of 4% and FV inhibitor of 8 BU. Although overt bleeding was not observed, administration of prednisolone was started. Her coagulation abnormalities were rapidly normalized. It was later determined that the patient had received bovine thrombin at surgery. The presence of a FV inhibitor should be considered in the differential diagnosis in patients demonstrating an unexpected prolongation of PT under warfarin therapy following surgery.

Topics: Aged, 80 and over; Animals; Anti-Bacterial Agents; Anticoagulants; Aortic Valve; Aortic Valve Stenosis; Cattle; Ceftriaxone; Factor V; Female; Heart Valve Prosthesis; Hemorrhagic Disorders; Humans; Immunosuppressive Agents; Partial Thromboplastin Time; Postoperative Complications; Prednisolone; Prothrombin Time; Pyelonephritis; Species Specificity; Thrombin; Warfarin