ISSN : 2146-3123
E-ISSN : 2146-3131

Panagiotis Andreadis1, Katerina Kafantari1, Aleka Agapidou2, Sofia Vakalopoulou1, Efthymia Vlachaki1
1Department of Internal Medicine, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece
2Department of Hematology, Homerton University Hospital, Homerton Row, London
DOI : 10.4274/balkanmedj.2017.0158


Background:Acquired coagulation Factor inhibitors are antibodies that either inhibit the activity or increase the clearance of a clotting factor leading to an increased risk of bleeding. Most of the times, the disorder is attributed to Factor VIII inhibition (Acquired Hemophilia A), however other coagulation factors could also be implicated.
Case Report:We herein would like to report an interesting case of a patient who underwent Coronary Artery Bypass Graft and received antibiotic treatment after surgery with a third-generation cephalosporin. A month later, hepresented with extreme bleeding diathesis and cerebral hemorrhage. Following a thorough clinical and laboratory investigation, an acquired Factor V Inhibitor was diagnosed. Patient received treatment with corticosteroids, intravenous immunoglobulins, anti–CD20 monoclonal antibodies (Rituximab), cyclophosphamide and recombinant Factor VIIa.
Conclusion:To our knowledge there have been only few similar cases reported to the literature. As there are no clear guidelines on acquired coagulation inhibitors treatment, report of such cases would offer insight for future therapy choices. The case that we discuss is unique because the treatment regimen included a combination of multiple therapeutic agents including rituximab. Finally, despite thepoor initial prognosis, patient managed to achieve a full recovery.

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