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Tang H, Luan X, Li J, Jiang G, Zhen H, Li H, Xiang W, Zhou J. Novel heterozygous
F7
gene mutation (c. C1286T) associated with congenital factor VII deficiency: A case report and literature review. J Clin Lab Anal 2022; 36:e24349. [PMID: 35349734 PMCID: PMC9102670 DOI: 10.1002/jcla.24349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/21/2022] [Accepted: 03/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background Congenital factor VII (FVII) deficiency is a rare inherited autosomal recessive disorder characterized by prolongation of prothrombin time and low FVII coagulation activity, which may increase the risk of bleeding. Case presentation A 66‐year‐old man with acute postoperative intracranial hemorrhage was transferred to our hospital owing to coagulation dysfunction. In coagulation tests, the FVII coagulation activity was less than 2%. Genetic analysis of the gene encoding FVII identified compound heterozygous mutations: c. 681+1 G>T and c. C1286T (p. Ala429Val). Conclusions To our knowledge, this is the first report describing the c. C1286T (p. Ala429Val) mutation in the FVII‐encoding gene. We suggest that these mutations resulted in the reduced FVII activity and abnormal clotting in our patient after brain surgery.
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Affiliation(s)
- Hua Tang
- Department of Neurosurgery the Affiliated Hospital of Southwest Medical University Lu Zhou China
- Southwest Medical University Lu Zhou China
| | - Xingzhao Luan
- Department of Neurosurgery the Affiliated Hospital of Southwest Medical University Lu Zhou China
- Southwest Medical University Lu Zhou China
| | - Jiaqi Li
- Department of Neurosurgery the Affiliated Hospital of Southwest Medical University Lu Zhou China
- Southwest Medical University Lu Zhou China
| | - Gen Jiang
- Department of Neurosurgery the Affiliated Hospital of Southwest Medical University Lu Zhou China
- Southwest Medical University Lu Zhou China
| | - Haowen Zhen
- Department of Neurosurgery the Affiliated Hospital of Southwest Medical University Lu Zhou China
- Sichuan Clinical Research Center for Neurosurgery Lu Zhou China
- Academician (Expert) Workstation of Sichuan Province Lu Zhou China
- Neurological Diseases and Brain Function Laboratory Lu Zhou China
| | - Hao Li
- Department of Neurosurgery the Affiliated Hospital of Southwest Medical University Lu Zhou China
- Sichuan Clinical Research Center for Neurosurgery Lu Zhou China
- Academician (Expert) Workstation of Sichuan Province Lu Zhou China
- Neurological Diseases and Brain Function Laboratory Lu Zhou China
| | - Wei Xiang
- Department of Neurosurgery the Affiliated Hospital of Southwest Medical University Lu Zhou China
- Sichuan Clinical Research Center for Neurosurgery Lu Zhou China
- Academician (Expert) Workstation of Sichuan Province Lu Zhou China
- Neurological Diseases and Brain Function Laboratory Lu Zhou China
| | - Jie Zhou
- Department of Neurosurgery the Affiliated Hospital of Southwest Medical University Lu Zhou China
- Sichuan Clinical Research Center for Neurosurgery Lu Zhou China
- Academician (Expert) Workstation of Sichuan Province Lu Zhou China
- Neurological Diseases and Brain Function Laboratory Lu Zhou China
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2
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Hu YN, Gan YM, Zhang YP, Ruan DD, Zhu YB, Lin XF, Fang ZT, Liao LS, Tang FQ, Luo JW. A novel compound heterozygous variant linked to hematuria in a family with hereditary factor VII deficiency. J Gene Med 2021; 24:e3398. [PMID: 34786791 DOI: 10.1002/jgm.3398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/06/2021] [Accepted: 09/28/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Hereditary Factor VII Deficiency (FVIID) is a rare congenital autosomal recessive bleeding disorder. In clinical manifestations, its onset is caused by variant of the F7 gene (NM_019616) with strong heterogeneity. We identified a family with hematuria caused by a novel F7 compound heterozygous variant and studied the FVIID-dependent mechanism impacted by these variants. METHODS Coagulation factors in the proband were functionally verified. We located pathogenic variants in relevant genes using next-generation sequencing after target enrichment and verified them by Sanger sequencing. We examined the coagulation activity and secretion pattern of recombinant FVII variants expressed in cells and observed their location and stability by immunofluorescence. RESULTS We found a missense variant c.1207G>A (p.Gly403Ser) and a frameshift variant c.154_155del (p.Arg53fs) in the F7 gene of the proband. FVII activity tests showed that the variants significantly decreased its presence in the cell culture supernatant. Moreover, the R53fs mutant lacked the FVII functional domain and had no detectable activity. Immunofluorescence indicated that the p.Gly403Ser variant was distributed to the cell membrane and cytoplasm, while the FVII R53fs variant was not detected. Deficient FVII protein function and severe coagulation disorder are the likely causes of hematuria and other bleeding symptoms in the proband. CONCLUSION The newly discovered F7 gene variants enrich the spectrum of hereditary FVII deficiency and provide a new foundation for the diagnosis and treatment of this type of coagulation disorder.
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Affiliation(s)
- Ya-Nan Hu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Fujian provincial hospital, Fuzhou, China
| | - Yu-Mian Gan
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Fujian provincial hospital, Fuzhou, China
| | - Yan-Ping Zhang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Fujian provincial hospital, Fuzhou, China
| | - Dan-Dan Ruan
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Fujian provincial hospital, Fuzhou, China
| | - Yao-Bin Zhu
- Department of Traditional Chinese Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xin-Fu Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Fujian provincial hospital, Fuzhou, China
| | - Zhu-Ting Fang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Fujian provincial hospital, Fuzhou, China
| | - Li-Sheng Liao
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Fujian provincial hospital, Fuzhou, China
| | - Fa-Qiang Tang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Fujian provincial hospital, Fuzhou, China
| | - Jie-Wei Luo
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Fujian provincial hospital, Fuzhou, China
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3
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Jain S, Donkin J, Frey MJ, Peltier S, Gunawardena S, Cooper DL. Phenotypical variability in congenital FVII deficiency follows the ISTH-SSC severity classification guidelines: a review with illustrative examples from the clinic. J Blood Med 2018; 9:211-218. [PMID: 30510462 PMCID: PMC6250109 DOI: 10.2147/jbm.s157633] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background One of the most common rare inherited bleeding disorders, congenital factor VII (FVII) deficiency typically has a milder bleeding phenotype than other rare bleeding disorders. Categorizing severity in terms of factor activity associated with hemophilia (severe <1%, moderate 1%–5%, mild 6%–40%) has led to the observation that bleeding phenotype does not follow closely with FVII activity. Over the past decade, large-scale global registries have investigated bleeding phenotype more thoroughly. The International Society on Thrombosis and Haemostasis has reclassified FVII deficiency as follows: severe, FVII <10%, risk of spontaneous major bleeding; moderate, FVII 10%–20%, risk of mild spontaneous or triggered bleeding; mild, FVII 20%–50%, mostly asymptomatic disease. Case reports Eleven illustrative cases of congenital FVII deficiency adapted from clinical practice are described to demonstrate the variability in presentation and in relation to FVII activity levels. Severe FVII deficiency usually presents at a young age and carries the risk of intracranial hemorrhage, hemarthrosis, and other major bleeds. Moderate FVII deficiency tends to present later, often in adolescence and particularly in girls as they reach menarche. Milder disease may not be apparent until found incidentally on preoperative testing, during pregnancy/childbirth, or following unexplained bleeding when faced with hemostatic challenges. Conclusion It is important for health care professionals to be aware of the new definitions of severity and typical presentations of congenital FVII deficiency. Failure to appreciate the risks of major bleeding, including intracerebral hemorrhage in those with FVII activity <10%, may put particularly young children at risk.
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Affiliation(s)
- Shilpa Jain
- Hemophilia Center of Western New York, Buffalo, NY, USA, .,Department of Pediatrics, Division of Pediatric Hematology-Oncology, John R. Oishei Children's Hospital, University of Buffalo, Buffalo, NY, USA,
| | - Jennifer Donkin
- Hemostasis and Thrombosis Center, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Skye Peltier
- Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis, MN, USA
| | - Sriya Gunawardena
- Clinical Development, Medical and Regulatory Affairs, Novo Nordisk Inc., Plainsboro, NJ, USA
| | - David L Cooper
- Clinical Development, Medical and Regulatory Affairs, Novo Nordisk Inc., Plainsboro, NJ, USA
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4
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Factor VII Deficiency: Clinical Phenotype, Genotype and Therapy. J Clin Med 2017; 6:jcm6040038. [PMID: 28350321 PMCID: PMC5406770 DOI: 10.3390/jcm6040038] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/12/2017] [Accepted: 03/23/2017] [Indexed: 12/14/2022] Open
Abstract
Factor VII deficiency is the most common among rare inherited autosomal recessive bleeding disorders, and is a chameleon disease due to the lack of a direct correlation between plasma levels of coagulation Factor VII and bleeding manifestations. Clinical phenotypes range from asymptomatic condition—even in homozygous subjects—to severe life-threatening bleedings (central nervous system, gastrointestinal bleeding). Prediction of bleeding risk is thus based on multiple parameters that challenge disease management. Spontaneous or surgical bleedings require accurate treatment schedules, and patients at high risk of severe hemorrhages may need prophylaxis from childhood onwards. The aim of the current review is to depict an updated summary of clinical phenotype, laboratory diagnosis, and treatment of inherited Factor VII deficiency.
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5
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Rabelo F, Jardim LL, Landau MB, Gadelha T, Corrêa MFB, Pereira I, Rezende SM. The molecular basis of low activity levels of coagulation factor VII: a Brazilian cohort. Haemophilia 2015; 21:670-80. [DOI: 10.1111/hae.12645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2015] [Indexed: 11/26/2022]
Affiliation(s)
- F.Y. Rabelo
- Faculty of Medicine; Universidade Federal de Minas Gerais; Belo Minas Gerais Brazil
| | - L. L. Jardim
- Faculty of Medicine; Universidade Federal de Minas Gerais; Belo Minas Gerais Brazil
| | | | - T. Gadelha
- Universidade Federal do Rio de Janeiro; Brazil
| | | | - I.F.M. Pereira
- University Hospital; Universidade Federal de Minas Gerais; Belo Horizonte Brazil
| | - S. M. Rezende
- Faculty of Medicine; Universidade Federal de Minas Gerais; Belo Minas Gerais Brazil
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6
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Abi-Nader KN, Rodeck CH, David AL. Prenatal gene therapy for the early treatment of genetic disorders. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.4.1.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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7
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Surgical interventions in childhood rare factor deficiencies: a single-center experience from Turkey. Blood Coagul Fibrinolysis 2013; 24:854-61. [PMID: 24158119 DOI: 10.1097/mbc.0b013e3283655667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Congenital rare factor deficiencies may present in infancy by life-threatening bleedings or may not show any symptoms until adulthood. It is reported more commonly in countries having consanguineous marriages. Data regarding surgical interventions of rare congenital factor deficiencies are based on case reports and records of guidelines. There are no well documented and separately prepared directories related to pre-surgical and prophylactic approaches of surgical interventions of these deficiencies. Our retrospective study consisted of 171 rare factor deficiencies that were followed up in our clinic, and of whom 61 had 88 surgical interventions between 1990 and 2012. Of these patients, 45 were having factor VII deficiency, and factor V, X, XI, XIII and fibrinogen deficiencies were present in five, four, three, two and two patients, respectively. In 23 patients, factor coagulant activities were under 5% (37.7%), in 15 it was between 5 and 30% (24.6%), and in 23 between 30 and 50% (37.7%). Twenty-eight were symptomatic and 33 were asymptomatic. Information of 51 (83.6%) male and 10 (16.4%) female patients with an age range of 5-25 years (13 ± 5.27), whose age at presentation ranged between 3 weeks and 18 years (7 ± 4.66), were retrieved from patient records and from the records contained in the data-processing environment introduced in 2005. The rate of familial consanguinity was 49.2%. Of the surgical interventions, 24 (27.3%) were major, 24 (27.3%) were minor and 40 (45.4%) were circumcision. We used fresh frozen plasma in 32, recombinant factor (rF)VIIa in 20, prothrombin complex concentrate in five and fibrinogen in three patients during surgical interventions. In 18 patients, antifibrinolytic agents were also used. In 27 patients, surgical interventions were applied without any replacement therapy. No additional doses were required after surgical prophylaxis doses. Thrombotic events were not observed. Antibody occurrence was not detected in these patients. In our study, we evaluated preparation for surgical procedures, factor replacement therapy before surgical intervention and postoperative follow-up in patients with rare coagulation factor deficiency.
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8
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Double heterozygous mutations Gln100Leu and His348Gln of the F7 gene in a patient with factor VII deficiency. Blood Coagul Fibrinolysis 2013; 24:199-201. [DOI: 10.1097/mbc.0b013e3283551132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Salcioglu Z, Akcay A, Sen HS, Aydogan G, Akici F, Tugcu D, Ayaz NA, Baslar Z. Factor VII deficiency: a single-center experience. Clin Appl Thromb Hemost 2012; 18:588-93. [PMID: 22327826 DOI: 10.1177/1076029611435091] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Congenital factor VII deficiency is the most common form of rare coagulation factor deficiencies. This article presents a retrospective evaluation of 73 factor VII deficiency cases that had been followed at our center. The study consisted of 48 males and 25 females (2 months-19 years). Thirty-one (42.5%) of them were asymptomatic. Out of symptomatic patients, 17 had severe clinical symptoms, whereas 8 presented with moderate and 17 with mild symptoms. The symptoms listed in order of frequency were as follows: epistaxis, petechia or ecchymose, easy bruising, and oral cavity bleeding. The genotype was determined in 8 patients. Recombinant activated factor VII (rFVIIa) was used to treat 49 bleeding episodes in 8 patients after 2002. In 2 patients with repeated central nervous system bleeding prophylaxis with rFVIIa was administered. No allergic and thrombotic events were observed during both treatment and prophylaxis courses. Antibody occurrence was not detected in the patients during treatment.
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Affiliation(s)
- Zafer Salcioglu
- Bakirkoy Children's and Maternity Education and Research Hospital, Istanbul, Turkey.
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10
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Landau D, Rosenberg N, Zivelin A, Staretz-Chacham O, Kapelushnik J. Familial factor VII deficiency with foetal and neonatal fatal cerebral haemorrhage associated with homozygosis to Gly180Arg mutation. Haemophilia 2010; 15:774-8. [PMID: 19432927 DOI: 10.1111/j.1365-2516.2009.02004.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Inherited factor VII (FVII) deficiency is a rare autosomal recessive disorder with a wide heterogeneous clinical pattern. Intracranial haemorrhage in infants has been previously reported in the severe form of the FVII deficiency and it has a high fatality rate. We report a family with high consanguineous relations, who experienced death of two baby girls, the first with prenatal manifestation of foetal hydrocephalus secondary to intracranial bleeding and the second with postnatal intracranial bleeding, both with less than 1% activity of FVII. Genetic analysis revealed that both parents are heterozygous and both daughters homozygous for a point mutation gG9639A in exon 7, predicting Gly180Arg substitution. This mutation was described previously in a compound heterozygous patient with mild bleeding manifestation. It seems that in this family, the mutation in its homozygous state is fatal and the lethal clinical expression can appear in utero at an early stage of gestation.
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Affiliation(s)
- D Landau
- Neonatal Department, Sheba Medical Center, Tel-Hashomer, Israel.
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11
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Daly ML, Giger U. A rodenticide exposed and bleeding Beagle dog with hereditary factor VII deficiency. J Vet Emerg Crit Care (San Antonio) 2007. [DOI: 10.1111/j.1476-4431.2006.00216.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Gupta N, Kamat D. A child with severe nosebleeds. Clin Pediatr (Phila) 2007; 46:184-6. [PMID: 17325095 DOI: 10.1177/0009922806297166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nimisha Gupta
- Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, MI 48210, USA
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Kim SH, Lim KJ, Yoon SZ, Park KS, Do SH. Clinical Experience with Recombinant Activated Factor VII in a Surgical Patient with Coagulation Factor VII Deficiency - A case report -. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.52.5.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sung-Hwan Kim
- Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Ji Lim
- Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Zhoo Yoon
- Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea
| | - Kum-Suk Park
- Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hwan Do
- Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea
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Pollak ES, Russell TT, Ptashkin B, Smith-Whitley K, Camire RM, Bauer KA. Asymptomatic Factor VII Deficiency in African Americans. Am J Clin Pathol 2006. [DOI: 10.1309/36hq36etu7k8muxt] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
Recombinant activated factor VII (rFVIIa) (NovoSeven) is a novel hemostatic agent originally developed to treat bleeding episodes in hemophilic patients with inhibitors against coagulation factors VIII and IX. In recent years, rFVIIa has also been employed for the management of uncontrolled bleeding in a number of congenital and acquired hemostatic abnormalities. Based on a literature search including PubMed, references from reviews, and abstracts from the most important meetings on this topic, this review examines the current knowledge on therapy with rFVIIa, from the now well-standardized uses to the newer and less well-characterized clinical applications.
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Affiliation(s)
- Massimo Franchini
- Servizio di Immunoematologia e Trasfusione - Centro Emofilia, Azienda Ospedaliera di Verona, Italy.
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16
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Hematoma abdominal y pélvico poslaparoscópico debido a déficit de factor VII. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2005. [DOI: 10.1016/s0210-573x(05)73479-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hewitt J, Ballard JNM, Nelson TN, Smith VC, Griffiths TAM, Pritchard S, Wu JK, Wadsworth LD, Casey B, MacGillivray RTA. Severe FVII deficiency caused by a new point mutation combined with a previously undetected gene deletion. Br J Haematol 2005; 128:380-5. [PMID: 15667541 DOI: 10.1111/j.1365-2141.2004.05296.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 3-week-old Caucasian female presented with severe unprovoked parenchymal cerebral haemorrhage. Her plasma factor VII (FVII) activity was <0.01 units/ml. FVII activities for her mother and sister were 0.65 units/ml and 0.51 units/ml, respectively, while her father's level was normal. These results indicated that the mother was heterozygous for a non-functional F7 gene that had also been inherited by the proband's sister. The proband's severe FVII deficiency was caused by a new mutation in her paternal F7 gene coupled with the inheritance of the non-functional maternal F7 gene. DNA sequence analysis revealed that the proband had apparent homozygosity for a novel single point mutation (g.3907G >A) changing the codon for Glu29 to Lys (E29K); neither parent had the E29K mutation. Because of the unlikelihood that the proband was homozygous for two identical new point mutations, the DNA sequence abnormality was more likely to have arisen from a single mutated gene on one allele and a F7 gene deletion on the other allele. Real time polymerase chain reaction (PCR) analysis confirmed that the proband had inherited a gene deletion that was present in the maternal side of the family. Subsequent clotting assays and real time PCR revealed that the maternal deletion also included the closely linked F10 gene.
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Affiliation(s)
- Jeff Hewitt
- Department of Biochemistry and Molecular Biology, University of Bristish Columbia, Vancouver, Canada
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