Department of Internal Medicine.
Department of Pathology and Laboratory Medicine.
Blood Coagul Fibrinolysis. 2021 Jun 1;32(4):294-297. doi: 10.1097/MBC.0000000000001009.
Factor V inhibitors are a rare cause of life-threatening bleeding. We present a case of an acquired factor V inhibitor likely caused by coronavirus disease 2019 infection. Bleeding was manifested by severe anemia requiring frequent red-cell transfusion, left psoas muscle hematoma, and left retroperitoneal cavity hematoma. Factor V activity was less than 1% and the factor V inhibitor titer was 31.6 Bethesda units. Severe acute respiratory syndrome coronavirus 2 RNA testing of the nasopharynx was positive 2 weeks before presentation and continued to be positive for 30 days. The patient failed treatment with intravenous immunoglobulin and dexamethasone. Three cycles of plasmapheresis with fresh frozen plasma replacement resulted in correction of the bleeding and laboratory coagulopathy. This is the first reported case of a factor V inhibitor in a coronavirus disease 2019 patient and suggests that plasmapheresis may be a successful treatment strategy.
凝血因子 V 抑制剂是导致严重致命性出血的罕见原因。我们报告了一例可能由 2019 年冠状病毒病（COVID-19）感染引起的获得性凝血因子 V 抑制剂。出血表现为严重贫血，需要频繁输血、左腰大肌血肿和左腹膜后腔血肿。凝血因子 V 活性<1%，凝血因子 V 抑制剂效价为 31.6 Bethesda 单位。在就诊前 2 周，患者的鼻咽部严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）RNA 检测呈阳性，并持续阳性 30 天。患者静脉注射免疫球蛋白和地塞米松治疗失败。3 个周期的血浆置换联合新鲜冷冻血浆置换纠正了出血和实验室凝血功能障碍。这是首例 COVID-19 患者出现凝血因子 V 抑制剂的报道，提示血浆置换可能是一种成功的治疗策略。
