Clinical and Laboratory Manifestations of 12 Patients With Factor V Inhibitors
| Patient . | Patient (age, sex) . | Factor V Level (%) . | Inhibitor Titer . | Bovine Thrombin Exposure . | Antibiotic Exposure . | Hemorrhagic Manifestations . | Reference . |
|---|---|---|---|---|---|---|---|
| Hemorrhagic anti–factor V antibodies | |||||||
| H1 | 51, M | ND | Inhibitory at >1:1,500-150 | No | Gentamicin, tetracycline, and erythromycin; prior streptomycin | Fatal spontaneous exsanguination | 4 |
| H3 | 67, M | 23-150 | 5 U-150 | No | Cefmetazole | Bloody sputum; bleeding from puncture site | — |
| RS | 64, M | <3.2 | 11 U | Topical thrombin | No | Bleeding from duodenal ulcer when heparin therapy initiated | 11 |
| RB | 82, M | <3.2 | ND | No | Cephradine | Hematuria and gastrointestinal bleeding | — |
| WH | ?, M | <3.2 | ∼35 U | Post-coronary artery bypass grafting | No | “Bleeding diathesis”-151 | — |
| AR | 75, F | >3.2 (inhibitory pattern) | ∼8 U-150 | No | Cephalexin (3 mo before admission) | Hematemesis, hematochezia, and hematuria | 21 |
| EM | 86, M | 58-150 (inhibitory pattern) | ND | Fibrin glue | Cephalexin | Hemorrhage from infected vascular graft site | — |
| RH | 55, M | <3.2 | ND | No | Cephalexin | No hemorrhagic symptoms at time of testing-152 | 22 |
| Nonhemorrhagic anti–factor V antibodies | |||||||
| H4 | 78, F | 19-150 | ND | No | No | None | — |
| H5 | 2, M | Not measurable | ND | Fibrin sealant | Imipenem-cilastatin and amphotericin B | None | 25 |
| MJ | 13, M | <3.2 | 2.2 U | Topical thrombin | No | None | 11 |
| BH | 60, M | <5-150 | 1.05 U-150 | No | No | None | — |
| Patient . | Patient (age, sex) . | Factor V Level (%) . | Inhibitor Titer . | Bovine Thrombin Exposure . | Antibiotic Exposure . | Hemorrhagic Manifestations . | Reference . |
|---|---|---|---|---|---|---|---|
| Hemorrhagic anti–factor V antibodies | |||||||
| H1 | 51, M | ND | Inhibitory at >1:1,500-150 | No | Gentamicin, tetracycline, and erythromycin; prior streptomycin | Fatal spontaneous exsanguination | 4 |
| H3 | 67, M | 23-150 | 5 U-150 | No | Cefmetazole | Bloody sputum; bleeding from puncture site | — |
| RS | 64, M | <3.2 | 11 U | Topical thrombin | No | Bleeding from duodenal ulcer when heparin therapy initiated | 11 |
| RB | 82, M | <3.2 | ND | No | Cephradine | Hematuria and gastrointestinal bleeding | — |
| WH | ?, M | <3.2 | ∼35 U | Post-coronary artery bypass grafting | No | “Bleeding diathesis”-151 | — |
| AR | 75, F | >3.2 (inhibitory pattern) | ∼8 U-150 | No | Cephalexin (3 mo before admission) | Hematemesis, hematochezia, and hematuria | 21 |
| EM | 86, M | 58-150 (inhibitory pattern) | ND | Fibrin glue | Cephalexin | Hemorrhage from infected vascular graft site | — |
| RH | 55, M | <3.2 | ND | No | Cephalexin | No hemorrhagic symptoms at time of testing-152 | 22 |
| Nonhemorrhagic anti–factor V antibodies | |||||||
| H4 | 78, F | 19-150 | ND | No | No | None | — |
| H5 | 2, M | Not measurable | ND | Fibrin sealant | Imipenem-cilastatin and amphotericin B | None | 25 |
| MJ | 13, M | <3.2 | 2.2 U | Topical thrombin | No | None | 11 |
| BH | 60, M | <5-150 | 1.05 U-150 | No | No | None | — |
Abbreviations: M, male; F, female; U, inhibitor units; and ND, not done.
Clinical laboratory studies not performed at Duke University Medical Center.
More definitive information concerning this patient and the hemorrhagic manifestations are unavailable.
At initial presentation, patient RH had “absent” factor V, an inhibitor titer >1,200 U, and severe hemorrhage.22 The sample investigated in this study was obtained at a time when the patient was no longer having hemorrhagic problems, and the inhibitor titer had reportedly decreased to 0.5-1.67 U.22