دورية
Successful Management of Bleeding in a Patient With Factor V Inhibitor by Platelet Transfusions
| العنوان: | Successful Management of Bleeding in a Patient With Factor V Inhibitor by Platelet Transfusions |
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| المؤلفون: | Chediak, Juan, Ashenhurst, Julia B., Garlick, Ivor, Desser, Richard K. |
| المصدر: | Blood; November 1980, Vol. 56 Issue: 5 p835-841, 7p |
| مستخلص: | A 71-yr-old male was seen because of the development of severe bleeding diathesis secondary to an acquired factor V inhibitor. The lack of clinical and laboratory response to fresh frozen plasma prompted us to treat him with platelet transfusions during 4 separate bleeding episodes; on each occasion he received 10–15 U of homologous platelet concentrates. There was a remarkable clinical response associated with a marked correction of the prolonged prothrombin time, prolonged partial thromboplastin time, and prolonged Russell viper venom time; this correlated with higher factor V levels and complete neutralization of the inhibitor. The beneficial effect of platelet transfusion lasted 5–6 days. The inhibitor was of low titer, and it was precipitated by staphylococcal protein A. The in vivo response to platelet transfusion correlated with subsequently performed in vitro experiments. Nonwashed control platelet pellets mixed with inhibitor plasma partially corrected the prolonged PTT, whereas washed platelets or albumin density gradient separated samples did not. Similarly, nonwashed platelets from a patient with congenital factor V deficiency had no corrective effect. Likely mechanisms of the effect of transfused platelets might include: (A) factor V was provided by platelets; (B) the platelet surface provided receptor sites for the factor V inhibitor; or (C) platelet participated in local hemostasis. Treatment of this patient with immunosuppression (cyclophosphamide and prednisone) resulted in disappearance of the inhibitor. Thus, platelet transfusions could be an alternative therapy to fresh frozen plasma in the treatment of bleeding in patients with factor V inhibitors. |
| قاعدة البيانات: | Supplemental Index |
| تدمد: | 00064971 15280020 |
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| DOI: | 10.1182/blood.V56.5.835.835 |