engleski

Unspecific acquired coagulation inhibitor in a 68- year old man

A 68-year-old man was admitted to the Emergency Department due to melena and hematemesis. In anamnesis patient had hypertension, diabetes mellitus type II, liver cirrhosis, myocardial infarction, four CABG and lately, prosthetic mitral valve replacement after which warfarin therapy was prescribed. In addition to his regular drug therapy, patient had been taking ibuprofen ten days before hospitalisation. Laboratory coagulation test results at admittance were: PT 26%, INR 2.44, APTT 44 s. Therapy with warfarin was stopped and low-molecular-weight heparin was administered. Four days after patient was stabilised (PT 42%) and warfarin therapy was continued. Ten days after hospitalisation patient was fully stabilised and released home. PT at discharge was 11%, INR 4.68. Control PT after 2 days without warfarin therapy was prescribed. Two days after control PT was <7%, INR >5.61. Patient was immediately admitted to the Emergency Department, without bleeding symptoms, and treated with 800 mL of fresh frozen plasma (FFP) and 20 mg of vitamin K. Six hours after treatment PT was <7%, INR >5.61. Administration of FFP continued during next 4 days with no improvement in PT, but still without bleeding symptoms. The following coagulation tests were performed: fibrinogen, PT, APTT, TT, fibrinolysis, FII, FV, FVII, FVIII, FX, antithrombin, protein C, LAC, aCL-IgG, aCL-IgM. Decreased values were determined for: FII 10%, FV <5%, FVII <5%, FVIII <5%, FX <5%, AT 40%, PC 43%. LAC, aCL-IgG and aCL-IgM values were immeasurable. PT and APTT were prolonged ; <7% and 69s, respectively. Mixture of patient plasma and FFP and mixture of patient plasma and normal control plasma were performed. PT was 10% and 12%, respectively. Five dilutions of the mixture of patient and normal control plasma were done. PT, APTT, FV, FVIII values were corrected to normal range values at the dilutions of 80x, 80x, 100x and 40x. During 10 days without any anticoagulant treatment patient values of PT and APTT had not demonstrated any improvement despite recombinant FVIIa and FFP administration. The test mixture dilutions of patient plasma and control normal plasma had shown presence of unspecific acquired coagulation inhibitor. It remains unclear whether this inhibitor is result of drug interactions and its in vivo activity.

unspecific inhibitor; coagulation inhibitor

nije evidentirano