Abstract Number: PB0294
Meeting: ISTH 2020 Congress
Theme: Coagulation and Natural Anticoagulants » Critical Care and Perioperative
Background: Cardiovascular surgery (CVS) accounts for fifteen percent of the annual blood supply use.
As transfusion is associated with sepsis, stroke, immune modulation and mortality, perioperative optimization is critical component of CVS. Particularly, in cases with complex coagulation challenges.
Aims: We describe a case of acquired factor VIII inhibitor in the setting of an aortic valve replacement (AVR); highlight the diagnostic challenges of acquired factor VIII inhibitors; and describe the utility of using PTT as a surrogate for quantification of the Factor VIII inhibitor.
Methods: 53-year-old female with rheumatoid arthritis on infliximab, presenting with anemia and left arm and neck swelling. An ultrasound identified a left brachial DVT. Two units of pRBCs were transfused and IV heparin was started.
A CT chest showed mediastinal lymphadenopathy and severe stenosis of the SVC. The echocardiogram demonstrated an aortic valve vegetation and severe regurgitation, which necessitated surgical management. A prolonged PTT in the setting of line associated bleeding, and diffuse hematomas prompted discontinuation of heparin and a complex coagulation workup.
Results: Normal thrombin time excluded heparin contamination. A mixing study suggested a factor inhibitor. Factor VIII was undetectable, the inhibitor was quantified at 17.60 Bethesda units and the corresponding PTT was 97.8. As the turnaround time for quantification of the Factor VIII and FVIII inhibitor is not readily available at our institution, we used the PTT as a surrogate marker. Before immunomodulation, a trial run of recombinant porcine FVIII (rPFVIII) was given and the PTT declined to 62 secs. In the setting of immunodulation, an overall retrospective correlation was noted between the PTT level and the factor VIII inhibitor trend. In the perioperative period, the patient was supported with rPFVIII and required minimal exposure to allogenic blood products.
Conclusions: PTT can be used as a surrogate marker of activity for Factor VIII inhibitor in perioperative period.
[Factor VIII Inhibitor Correlation]
To cite this abstract in AMA style:
Klein K, Chen A, Allison P, Akkanti B, Hussain R, Dinh K, Akay M, Salas I, Gregoric I, Kar B, PatarroyoAponte M, Jumean M, Kumar S, Nathan S, Kaur S, Sachedina A, Escobar M, Cervoni F, Tint H. PTT a Surrogate for Quantification of Factor VIII Inhibitor [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/ptt-a-surrogate-for-quantification-of-factor-viii-inhibitor/. Accessed March 21, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/ptt-a-surrogate-for-quantification-of-factor-viii-inhibitor/