Abstract Number: PB0688
Meeting: ISTH 2020 Congress
Background: There are reports of patients with Factor V inhibitor in exposure to bovine thrombin, surgery, antibiotic therapy (β-lactam or aminoglycoside group) and oncohematological diseases.
Aims: To report a case acquired Factor V inhibitor with Strongiloidiasis and antibiotic therapy.
Methods: Patient78-year-old male, with a history of partial prostactectomy, chronic renal failure, choledocytic and vesicular lithiasis, cholangitis, biliary focus sepsis in empirical treatment with Imipenem, fibrillation and atrial flutter initially anticoagulated with rivaroxaban and subsequently with antivitamin K (AVK) . Because of suspiction of psoas hematoma AVK was suspended and thromboprophylaxis with low molecular weight heparin was started. Hematoma was ruled out and right psoas abscess (Echerichia coli associated with pleural effusion) was confirmed. A treatment for 28 days with ceftriaxone and Strongyloidiasis diagnostic were carried out.
Retrospective analysis of the patient´s medical history. Coagulation laboratory studies: Prothrombin time (PT): Thromborel, Siemens. Partial Activated Thromboplastin Time (APTT): Pathromtin SL, Siemens. Fibrinogen: Dade Thrombin Reagent (Clauss), Siemens. Waveform analysis. Platelet count: Advia 2120. Thrombin time: Thrombin Time, Siemens. Factor measurement in 3 dilutions: Deficient plasma and Siemens calibrator. Lupus Anticoagulant: LA1 and LA2, Siemens; Silica Clotting Time: Instrumentation laboratory. Coagulometer: Sysmex CS-2500.
Results: See Table
| Assay (Reference Value) | 04/2019 | 01/ 07/2019 | 30/07/19-02/08/19 | 26/ 08/2019 | 02/ 09/2019 | 11/2019 |
| Prothrombin Time PT: (70%-120%) / APTT (24-42 sec) | 27 / 38 | 32 / 38 | 86 / 31 | <5 / 169 | 36 / 51 | 79 / 35 |
| Fibrinogen (200-400 mg/dL) / Thrombin Time TT: (12-20 sec) | * / * | * / * | * / * | 445 / 16 | 378 / 16 | * / * |
| waveform análisis TP, APTT / Platelets (200-400 ^ 103 uL) | * / * | * / * | * / 277 | Alteraded / 252 | Normal / 243 | * / 290 |
| PT(%), Normal Pool / APTT,Normal Pool | * / * | * / * | * / * | 93 / 30 | 90 / 33 | * / * |
| PT (%), Mix Pat+Normal / APTT, Mix Pat+Normal | * / * | * / * | * / * | 25 (fail corrected) / 52 (fail corrected) | 65 / 36 | * / * |
| Factors II, VII, IX, X, XI, FVIII one stage and chromogenic | * | * | * | Normal (increase activity with dilution) | Normal | * |
| Factor XII (50%-150%) / Factor V (70%-120%) | * / * | * / * | * / * | 30 / <5 | 40 / 20 | * / 90 |
| Lupus Anticoagulant | * | * | * | Not determinable by inhibitor interference | Negative (tested on the mixture P1:N1) | * |
| Inhibitor aFV (<0,6 UB/ml) | * | * | * | 5.0 (Positive) | 0.2 (Negative) | Negative |
[Results]
Conclusions: Due to the suspicion that the development of the inhibitor might have followed to strongyloidiasis and antibiotic therapy, ceftriaxone was suspended and rotated to endovenous Ertapenem until 6 weeks are completed and treatment for Strongyloides with Ivermectin is performed. Then the patient normalizes the PT (%) and negativizes the FV inhibitor, with later normalization of FV levels. This inhibitor could be associated with the use of antibiotics, in an anticoagulated patient with strongiloidiasis.
To cite this abstract in AMA style:
Sueldo E, Cermelj M, Arias MDV. Factor V inhibitor in a patient with Strongyloides Stercolaris and antibiotic therapy [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/factor-v-inhibitor-in-a-patient-with-strongyloides-stercolaris-and-antibiotic-therapy/. Accessed November 29, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/factor-v-inhibitor-in-a-patient-with-strongyloides-stercolaris-and-antibiotic-therapy/