Life-threatening bleeding tendency provoked by an acquired isolated factor X deficiency associated with respiratory infe
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LETTER TO THE EDITOR
Life-threatening bleeding tendency provoked by an acquired isolated factor X deficiency associated with respiratory infection L. Coucke & S. Trenson & D. Deeren & I. Van haute & K. Devreese
Received: 9 January 2013 / Accepted: 21 February 2013 # Springer-Verlag Berlin Heidelberg 2013
Dear Editor, Acquired factor X deficiencies (FXD) are common in the setting of vitamin K deficiency, vitamin K antagonist therapy, or liver disease. Isolated acquired FXD is rare and predominantly described with monoclonal immunoglobulin deposition diseases due to direct factor X binding to amyloid fibrils [1]. Other associated diseases include myeloma, acute leukemia, and solid tumors [2]. Since 1965, there are as few as 34 cases reporting isolated acquired FXD in the absence of amyloidosis or plasma cell dyscrasia [3]. A 52-year-old male presented to the emergency department with fever, coughing, and severe abdominal pain. Two weeks prior to admission, amoxicillin, clarithromycin, and moxifloxacin were subsequently prescribed for a nonresolving pharyngitis. The patient had no relevant family or personal medical history. He was taking no medication other than acetaminophen. He smoked 10 cigarettes a day (15 packyears). Over the days following to admission, he developed macroscopic hematuria and epistaxis. CT thorax demonstrated a pneumonia in the right lobe. Laboratory data showed
L. Coucke (*) : K. Devreese Coagulation Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital, De Pintelaan, 185 (2P8), 9000 Ghent, Belgium e-mail: [email protected] S. Trenson : D. Deeren Clinical Haematology, H.-Hartziekenhuis Roeselare-Menen vzw, Roeselare, Belgium I. Van haute Clinical Laboratory, H.-Hartziekenhuis Roeselare-Menen vzw, Roeselare, Belgium
leukocytosis 13.8×109/L (3.7–9.5×109/L) with left shifted differentiation, a platelet count of 274×109/L (150–450× 109/L), C-reactive protein of 7.3 mg/dL (0–0.7 mg/dL), and normal renal and liver function tests. Serum protein electrophoresis showed minimal deviation in the gammaglobulin fraction but the free light chain ratio was within normal limits. Coagulation results were prolonged, both the activated partial thromboplastin time (aPTT) of 144.1 s (28.0–39.0 s) and the prothrombin time (PT) of 6 % (70– 116 %) with an INR of 17.7. Thrombin time was 17.8 s (14.0–21.0 s). D-dimers were 0.3 mcg/mL (
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