Recessively inherited protein C deficiency in two sisters: intracerebral hemorrhage and coagulopathy complications.

Background: Protein C (PROC) deficiency is a rare hematological disorder caused by mutations in the PROC gene, leading to severe coagulopathy in homozygous cases. This report highlights the hematological challenges in managing homozygous protein C deficiency, particularly its association with intracerebral hemorrhage and thrombosis.

Case report: We describe two sisters with a homozygous PROC gene mutation (c.797A>G, p.Tyr266Cys), presenting with protein C activity <10%. The older sister (born 2020) developed neonatal intracerebral hemorrhage, followed by recurrent hemorrhage and deep vein thrombosis by 2025, managed with heparin, warfarin, and rivaroxaban. The younger sister (born 2022) also experienced neonatal hemorrhage and required anticoagulant therapy with heparin and warfarin. Both developed neurological complications, including epilepsy.

Conclusion: Homozygous protein C deficiency can lead to severe neonatal coagulopathy, necessitating early diagnosis and aggressive anticoagulant therapy. This case underscores the importance of multidisciplinary management and genetic screening in affected families.