[Acquired factor Ⅴ inhibitor induced by surgical trauma complicated with fatal hemorrhage: a case report and literature review].

Abstract

Objective: To explore the diagnosis, treatment, and prognosis of patients with acquired factor Ⅴ inhibitors. Methods: We analyzed a case of acquired factor Ⅴ inhibitor treated in the department of critical care medicine at Shanghai East Hospital in 2022. A literature review was conducted using the search terms [ ("Factor V" OR "Factor V Inhibitors") AND ("Autoantibodies" OR "Immune System Diseases") ] AND [acquired (Title/Abstract) OR autoimmune (Title/Abstract) OR inhibitor (Title/Abstract) ] in the PubMed database. Chinese databases (Wanfang, VIP, and CNKI) were searched using (acquired factor V inhibitor OR acquired coagulation factor V inhibitor OR coagulation factor V antibody OR coagulation factor V autoantibody) AND (deficiency OR inhibition OR dysfunction) . Results: A 56-year-old male was admitted to the department of critical care medicine due to coagulopathy following surgery. Laboratory tests showed normal blood routine but revealed prolonged PT of 76.7 s, APTT of 83.1 s, and an INR of 7.14. Coagulation factor assays indicated factor V activity at 8.4%, which continued to decline. Immediate and 2-hour delayed mixing studies failed to correct the coagulation abnormalities. The factor V inhibitor titer was measured at 8 BU/ml. It was considered that surgical trauma induced the production of an acquired factor V inhibitor, leading to fatal bleeding. After treatment with corticosteroids, cyclophosphamide, and plasma exchange, the coagulation abnormalities were corrected. The literature search identified 16 cases reported in China and approximately 200 cases reported globally. Conclusion: Patients with acquired factor V inhibitors exhibit diverse clinical manifestations. Current treatment options include combined therapies such as supportive care, corticosteroids, immunosuppressants, and plasma exchange. The prognosis of patients depends on the inducing factors and the timeliness of diagnosis and treatment.