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Ogawa Y, Ichinose A, Yanagisawa K, Souri M, Osaki T, Kanaya S, Handa H. Retrospectively diagnosed autoimmune VWF deficiency in a patient with repeated hemorrhagic events after two common colds. Int J Hematol 2024; 120:375-381. [PMID: 38761278 DOI: 10.1007/s12185-024-03782-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/20/2024]
Abstract
Autoimmune von Willebrand factor (VWF) deficiency (AiVWFD) caused by anti-VWF autoantibodies is a rare bleeding disorder, whereas "non-immune" acquired von Willebrand syndrome (AVWS) caused by other etiologies is more common. Therefore, only 40 patients with AiVWFD have been identified in Japan through an ongoing nationwide survey on autoimmune coagulation factor deficiencies. This may be due to the inability to efficiently detect anti-VWF antibodies, as anti-VWF antibody testing is not routine. An 80-year-old Japanese woman developed AVWS and experienced bleeding after two separate common colds. She took the same cold medicine each time and recovered spontaneously after discontinuation of the medicine. Severe VWF deficiency normalized each time. Initial immunological tests did not detect anti-VWF autoantibodies, and thus a diagnosis of "non-immune" AVWS of unknown origin was made. However, after 6 years, new ELISA assays using purified VWF proteins detected free anti-VWF autoantibodies, which led to a retrospective diagnosis of AiVWFD. It is probable that the cold medicine (and/or cold virus infection) induced the autoantibodies, as the recurrence and normalization of the same coagulation abnormality and the clinical course (including drug administration and discontinuation) were completely synchronized. If AiVWFD is suspected, highly sensitive autoantibody tests should be performed.
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Affiliation(s)
- Yoshiyuki Ogawa
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
- The Japanese Collaborative Research Group (JCRG) On Autoimmune Acquired Coagulation Factor Deficiencies Supported By the Japanese Ministry of Health, Labor and Welfare (MHLW), Yamagata, Japan
| | - Akitada Ichinose
- The Japanese Collaborative Research Group (JCRG) On Autoimmune Acquired Coagulation Factor Deficiencies Supported By the Japanese Ministry of Health, Labor and Welfare (MHLW), Yamagata, Japan.
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
| | - Kunio Yanagisawa
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masayoshi Souri
- The Japanese Collaborative Research Group (JCRG) On Autoimmune Acquired Coagulation Factor Deficiencies Supported By the Japanese Ministry of Health, Labor and Welfare (MHLW), Yamagata, Japan
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
- Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science, Yamagata, Japan
| | - Tsukasa Osaki
- The Japanese Collaborative Research Group (JCRG) On Autoimmune Acquired Coagulation Factor Deficiencies Supported By the Japanese Ministry of Health, Labor and Welfare (MHLW), Yamagata, Japan
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
- Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science, Yamagata, Japan
| | - Shuhei Kanaya
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroshi Handa
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
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Ceasovschih A, Alexa RE, Șorodoc V, Balta A, Constantin M, Coman AE, Petriș OR, Stătescu C, Sascău RA, Onofrei V, Diaconu AD, Morărașu BC, Rusu-Zota G, Șorodoc L. Persistent Gastrointestinal Bleeding after Aortic Valve Replacement in Heyde's Syndrome. J Clin Med 2024; 13:4515. [PMID: 39124781 PMCID: PMC11313494 DOI: 10.3390/jcm13154515] [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: 05/14/2024] [Revised: 07/10/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Heyde's syndrome (HS) represents an association between aortic stenosis and intestinal angiodysplasias, and it has been demonstrated that acquired von Willebrand disease plays a pivotal role in the pathophysiology of this syndrome. In patients with HS, von Willebrand factor deficiency represents an additional risk factor, further contributing to the risk of bleeding and anemia. We present the case of an 86-year-old patient diagnosed with HS and von Willebrand deficiency in 2018. Four years prior, the patient underwent surgical aortic valve replacement. Since then, she has been receiving chronic oral anticoagulation therapy with a vitamin K antagonist. The patient was admitted to the Internal Medicine Clinic due to semi-solid dark stools, diffuse abdominal pain, and asthenia. Upon examination, the patient presented with an altered general status and clinical signs suggestive of anemia. Laboratory findings revealed anemia with elevated INR and aPTT values. Colonic angiodysplasias were identified during a colonoscopy, although no sources of active bleeding were detected. On the 9th day of hospitalization, the patient experienced an episode of lower gastrointestinal bleeding. The pharmacological management was adjusted, and argon plasma coagulation was recommended. Following treatment of the angiodysplastic lesions, the patient's clinical evolution was favorable, with the correction of the anemia.
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Affiliation(s)
- Alexandr Ceasovschih
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.); (M.C.); (A.E.C.); (O.R.P.); (C.S.); (R.A.S.); (V.O.); (A.-D.D.); (B.C.M.); (G.R.-Z.); (L.Ș.)
- Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania; (R.-E.A.); (A.B.)
| | - Raluca-Elena Alexa
- Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania; (R.-E.A.); (A.B.)
| | - Victorița Șorodoc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.); (M.C.); (A.E.C.); (O.R.P.); (C.S.); (R.A.S.); (V.O.); (A.-D.D.); (B.C.M.); (G.R.-Z.); (L.Ș.)
- Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania; (R.-E.A.); (A.B.)
| | - Anastasia Balta
- Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania; (R.-E.A.); (A.B.)
| | - Mihai Constantin
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.); (M.C.); (A.E.C.); (O.R.P.); (C.S.); (R.A.S.); (V.O.); (A.-D.D.); (B.C.M.); (G.R.-Z.); (L.Ș.)
- Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania; (R.-E.A.); (A.B.)
| | - Adorata Elena Coman
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.); (M.C.); (A.E.C.); (O.R.P.); (C.S.); (R.A.S.); (V.O.); (A.-D.D.); (B.C.M.); (G.R.-Z.); (L.Ș.)
- Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania; (R.-E.A.); (A.B.)
| | - Ovidiu Rusalim Petriș
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.); (M.C.); (A.E.C.); (O.R.P.); (C.S.); (R.A.S.); (V.O.); (A.-D.D.); (B.C.M.); (G.R.-Z.); (L.Ș.)
- Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania; (R.-E.A.); (A.B.)
| | - Cristian Stătescu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.); (M.C.); (A.E.C.); (O.R.P.); (C.S.); (R.A.S.); (V.O.); (A.-D.D.); (B.C.M.); (G.R.-Z.); (L.Ș.)
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, 700503 Iasi, Romania
| | - Radu A. Sascău
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.); (M.C.); (A.E.C.); (O.R.P.); (C.S.); (R.A.S.); (V.O.); (A.-D.D.); (B.C.M.); (G.R.-Z.); (L.Ș.)
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, 700503 Iasi, Romania
| | - Viviana Onofrei
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.); (M.C.); (A.E.C.); (O.R.P.); (C.S.); (R.A.S.); (V.O.); (A.-D.D.); (B.C.M.); (G.R.-Z.); (L.Ș.)
- Department of Cardiology, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Alexandra-Diana Diaconu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.); (M.C.); (A.E.C.); (O.R.P.); (C.S.); (R.A.S.); (V.O.); (A.-D.D.); (B.C.M.); (G.R.-Z.); (L.Ș.)
- Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania; (R.-E.A.); (A.B.)
| | - Bianca Codrina Morărașu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.); (M.C.); (A.E.C.); (O.R.P.); (C.S.); (R.A.S.); (V.O.); (A.-D.D.); (B.C.M.); (G.R.-Z.); (L.Ș.)
- Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania; (R.-E.A.); (A.B.)
| | - Gabriela Rusu-Zota
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.); (M.C.); (A.E.C.); (O.R.P.); (C.S.); (R.A.S.); (V.O.); (A.-D.D.); (B.C.M.); (G.R.-Z.); (L.Ș.)
- Department of Pharmacology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Laurențiu Șorodoc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.); (M.C.); (A.E.C.); (O.R.P.); (C.S.); (R.A.S.); (V.O.); (A.-D.D.); (B.C.M.); (G.R.-Z.); (L.Ș.)
- Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania; (R.-E.A.); (A.B.)
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Zablonski KG, Rajkumar A, Nayak L. Intravenous Immunoglobulin offers temporary improvement in acquired von Willebrand syndrome due to monoclonal gammopathy: A case report. EJHAEM 2024; 5:833-837. [PMID: 39157619 PMCID: PMC11327770 DOI: 10.1002/jha2.969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 08/20/2024]
Abstract
Acquired von Willebrand syndrome (AVWS) is a bleeding disorder in which an underlying condition induces a quantitative or qualitative deficiency in the von Willebrand factor. This case demonstrates the rare diagnosis of AVWS due to an Immunoglobulin G monoclonal gammopathy in an elderly woman who presented with significant gastrointestinal bleeding. Originally thought to be type 1 von Willebrand disease, this case provides a cautious example to clinicians that without a detailed history or an understanding of the associated laboratory work-up, AVWS may be missed with potentially fatal consequences. Fortunately, AVWS was recognized and treated with intravenous immunoglobulin with a resolution of bleeding.
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Affiliation(s)
| | | | - Lalitha Nayak
- University Hospitals, Seidman Cancer CenterClevelandOhioUSA
- Department of Internal MedicineCase Western Reserve UniversityClevelandOhioUSA
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Alamin AA. Thrombocytopenia and Bleeding in Chronic Kidney Disease: A Case of Acquired Von Willebrand Syndrome. Cureus 2024; 16:e65834. [PMID: 39219970 PMCID: PMC11363469 DOI: 10.7759/cureus.65834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
Acquired von Willebrand disease is a rare condition with laboratory findings similar to the inherited type, which can be autosomal dominant or recessive. This case describes a rather rare clinical situation of a 65-year-old man with stage 4 chronic kidney disease who also had acquired von Willebrand syndrome (AvWS) with thrombocytopenia and bleeding. The patient had a complaint of easy fatigability, easy bruising, and prolonged bleeding from small cuts. The patient's initial laboratory workup included thrombocytopenia, which on further evaluation established the diagnosis of AvWS due to chronic kidney disease. More specific examination revealed reduced activity of the von Willebrand factor. The patient was managed with desmopressin and von Willebrand factor concentrates and there was a transient rise in platelet count and relief of symptoms of bleeding. This case underlines the importance of AvWS in any differential diagnosis of thrombocytopenia in patients with chronic kidney disease. This report aims to provide recommendations for early identification and management of AvWS to improve the outcome.
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Affiliation(s)
- Amin A Alamin
- Pathology, College of Medicine, Taif University, Taif, SAU
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Archibald WJ, Kouides PA, Refaai MA, Lachant NA. Acquired bleeding disorders secondary to immune checkpoint inhibitors: a case report and systematic literature review. Blood Coagul Fibrinolysis 2023; 34:427-431. [PMID: 37695569 DOI: 10.1097/mbc.0000000000001244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Acquired bleeding disorders because of an autoimmune phenomenon are rare events. Acquired von Willebrand disease (aVWD) has been estimated as having a prevalence of 400 per million in the general population. Acquired hemophilia A (AHA), the most common of the acquired hemophilias, has an estimated incidence of 1.3-1.5 cases per million per year. Immune checkpoint inhibitors (ICI) targeting PD-1, PD-L1, and CTLA-4 are being used with increasing frequency for hematologic and oncologic disorders. Acquired hemophilias and aVWD have been reported with the use of ICI therapy. We performed a systematic review of the literature to identify cases of acquired bleeding disorders with ICI therapy and contribute our own institution's experience with a case of AHA after pembrolizumab therapy. Six cases of AHA, one case of aVWD, and one case of factor V inhibitor were identified in the literature. Inhibitors were successfully eradicated in five of the eight cases identified. We propose that a centralized registry, possibly through the Scientific and Standardization Subcommittee on Plasma Coagulation Inhibitors through the International Society on Thrombosis and Hemostasis (ISTH), be developed to record treatment and outcomes of this rare ICI complication in order to prognosticate risk and better understand optimal treatment strategies.
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Affiliation(s)
- William J Archibald
- James P Wilmot Cancer Institute, Division of Hematology and Medical Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry
| | | | - Majed A Refaai
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Neil A Lachant
- James P Wilmot Cancer Institute, Division of Hematology and Medical Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry
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Lovell K, Peters B, Pasli M, Kennedy K, Liles D, Pories W. Fasciotomy on a female patient with acquired factor VIII: A case report and literature review of management. Clin Case Rep 2023; 11:e7773. [PMID: 37546159 PMCID: PMC10400796 DOI: 10.1002/ccr3.7773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023] Open
Abstract
Key Clinical Message Acquired factor VIII inhibitors can be a rare cause of extensive intramuscular bleeding requiring fasciotomy. The subsequent postoperative period requires close monitoring due to high risk of fatal blood loss. Abstract Acquired factor VIII inhibitors are a rare cause of often extensive bleeding and subsequently large hematomas. This disorder's overall mortality can reach 38%, largely due to immunosuppression and subsequent infections or an underlying cause such as malignancy. The patient in this case study presented with a hematoma and extensive ecchymosis of the hand and forearm, which continued to progress, precipitating compartment syndrome of the hand and forearm and ultimately requiring fasciotomy. The combination of factors led to significant blood loss in the postoperative period requiring major fluid resuscitation and intensive care unit (ICU) level care. Due to this disorder's rarity and overall mortality, we present this case report with a literature review for management of acquired hemophilia in the setting of urgent fasciotomy.
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Affiliation(s)
- Katie Lovell
- East Carolina University Brody School of MedicineGreenvilleNorth CarolinaUSA
| | - Bethlehem Peters
- East Carolina University Brody School of MedicineGreenvilleNorth CarolinaUSA
| | - Melisa Pasli
- East Carolina University Brody School of MedicineGreenvilleNorth CarolinaUSA
| | - Katie Kennedy
- Department of Hematology/OncologyECU Health Brody School of MedicineGreenvilleNorth CarolinaUSA
| | - Darla Liles
- Department of Hematology/OncologyECU Health Brody School of MedicineGreenvilleNorth CarolinaUSA
| | - Walter Pories
- Department of SurgeryECU Health Brody School of MedicineGreenvilleNorth CarolinaUSA
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Nikolina B, Marija M, Marija B, Maja M, Dubravka P. Acquired hemophilia A secondary to SARS-CoV-2 pneumonia: a case report. Biochem Med (Zagreb) 2022; 32:030801. [PMID: 35966257 PMCID: PMC9344868 DOI: 10.11613/bm.2022.030801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/23/2022] [Indexed: 11/23/2022] Open
Abstract
The acquired hemophilia A (AHA) is a life-threatening condition. The incidence of AHA is extremely low, which requires a multidisciplinary approach to diagnosis and treatment. This is case report of 73-year-old man who presented with AHA secondary to severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) pneumonia. The patient had extensive skin bleeding and hematomas. In the coagulation screening tests activated partial thromboplastin time (APTT) was prolonged with normal prothrombin time (PT), which was indication for further investigation. The APTT in a mixing study with normal plasma did not correct so clotting factors inhibitors were suspected. With signs of bleeding, extremely low factor VIII (FVIII) activity (2%) and presence of FVIII inhibitors, AHA was diagnosed and treatment initiated. Patient was treated with factor eight inhibitor bypassing agent (FEIBA) for three days, followed by long-term corticosteroid and cyclophosphamide therapy. Malignant and autoimmune diseases as the most common causes of AHA were ruled out. The patient had a good response to therapy with gradual normalization of APTT and FVIII activity. To the best of our knowledge, the present case is the first reported case of de novo AHA after SARS-CoV-2 pneumonia. The diagnosis of AHA should be suspected in a patient with bleeding into the skin and mucous membranes without a previous personal and family history of bleeding, and with isolated prolonged APTT. It is important to investigate any isolated prolongation of APTT in cooperation with clinical laboratory experts.
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Affiliation(s)
- Brkić Nikolina
- Department of Transfusion Medicine, General County Hospital Vinkovci, Vinkovci, Croatia
- Faculty of Medicine, University of Osijek, Osijek, Croatia
- Corresponding author:
| | - Milić Marija
- Clinical Institute of Laboratory Diagnostics, University Hospital Osijek, Osijek, Croatia
- Faculty of Medicine, University of Osijek, Osijek, Croatia
| | - Bekavac Marija
- Department of Transfusion Medicine, General County Hospital Vinkovci, Vinkovci, Croatia
| | - Marković Maja
- Department of Hematology, University Hospital Osijek, Osijek, Croatia
| | - Perković Dubravka
- Clinical Institute of Transfusion Medicine, University Hospital Osijek, Osijek, Croatia
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Life-threatening chlorpromazine-induced acquired haemophilia A in a patient with a cavernous malformation involving the medulla oblongata. Rev Med Interne 2022; 43:739-742. [PMID: 36075795 DOI: 10.1016/j.revmed.2022.08.009] [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: 04/10/2022] [Revised: 07/26/2022] [Accepted: 08/24/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Chlorpromazine is a commonly used drug in several medical conditions associated with a wide range of side effects. Few cases of hemostatic disorder have been reported in the literature. CASE REPORT A 39-year-old man had previously been diagnosed with a cavernous malformation of the medulla oblongata. Chlorpromazine was started to treat persistent hiccups. Twenty days later, the patient presented hepatitis and a pruritic rash. Haemostasis tests revealed a prolonged partial thromboplastin time associated with isolated decrease of factor VIII level and anti-factor VIII antibodies. Magnetic resonance imaging revealed recent asymptomatic bleeding. Introduction of eptacog alfa and prednisone allowed clinical and biological improvement as well as a prolonged remission after 12 months of follow-up.
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Tang Q, Liao J, Xie X. Acquired Hemophilia Associated with Rheumatic Diseases: A Case-Based Systematic Review. J Inflamm Res 2022; 15:4385-4393. [PMID: 35945991 PMCID: PMC9357396 DOI: 10.2147/jir.s369288] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/19/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Qi Tang
- Department of Rheumatology and Immunology, the Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Jiafen Liao
- Department of Rheumatology and Immunology, the Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Xi Xie
- Department of Rheumatology and Immunology, the Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Correspondence: Xi Xie, Department of Rheumatology and Immunology, the Second Xiangya Hospital, Central South University, Changsha, 410011, People’s Republic of China, Tel/Fax +86 0731 8529 5255, Email
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Ichinose A, Osaki T, Souri M, Favaloro EJ. A Review of Autoimmune Acquired von Willebrand Factor Deficiency in Japan. Semin Thromb Hemost 2022; 48:911-925. [PMID: 35803264 DOI: 10.1055/s-0042-1749088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
von Willebrand factor (VWF) forms high-molecular-weight multimers and plays an essential role in hemostasis, and thus its deficiency leads to bleeding symptoms. Acquired von Willebrand syndrome (AVWS) is rare, but potentially underdiagnosed, and develops in various underlying disorders. AVWS caused by anti-VWF autoantibodies is a rare subcategory of AVWS that can also be referred to as autoimmune VWF deficiency (AiVWFD). We performed a search of patients with autoimmune coagulation factor deficiencies in our nationwide survey in Japan. Among these, suspected cases of AiVWFD were extremely few, with only 11 case consultations in the last 10 years. Of these, three and five were respectively positive for anti-VWF autoantibodies (anti-VWF-Ab) and VWF inhibitor (VWF-inh). We also performed an extensive literature search of other cases from Japan, and in total, 40 cases were finally identified to have AiVWFD, with mean age of 55.0 years. Most underlying disorders were lympho- or myeloproliferative diseases, followed by autoimmune diseases. The major bleeding sites were subcutaneous and mucosal, the bleeding severity was moderate, and there were no hemorrhagic deaths. Bleeding time was prolonged; factor VIII activity, VWF antigen, and VWF activity were decreased, and high-molecular-weight VWF multimers were absent or decreased. These are similar to the common abnormal laboratory findings observed among general AVWS cases. Hemostatic therapy often involved VWF concentrates and vasopressin, and antibody eradication therapy often included corticosteroids and achieved remission. Notably, of all cases, 68% had anti-VWF-Abs, and 83% of anti-VWF-Ab-positive patients were also VWF-inh positive. To accumulate precise clinical information on AiVWFD, it is necessary to verify and improve the measurement methods for both anti-VWF-Ab and anti-VWF-inh. These findings from Japan should be confirmed in other geographic localities.
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Affiliation(s)
- Akitada Ichinose
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata, Japan.,The Japanese Collaborative Research Group (JCRG) on Autoimmune Acquired Coagulation Factor Deficiencies supported by the Japanese Ministry of Health, Labor and Welfare (MHLW), Yamagata, Japan
| | - Tsukasa Osaki
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata, Japan.,The Japanese Collaborative Research Group (JCRG) on Autoimmune Acquired Coagulation Factor Deficiencies supported by the Japanese Ministry of Health, Labor and Welfare (MHLW), Yamagata, Japan.,Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science, Iida-Nishi, Yamagata, Japan
| | - Masayoshi Souri
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata, Japan.,The Japanese Collaborative Research Group (JCRG) on Autoimmune Acquired Coagulation Factor Deficiencies supported by the Japanese Ministry of Health, Labor and Welfare (MHLW), Yamagata, Japan.,Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science, Iida-Nishi, Yamagata, Japan
| | - Emmanuel J Favaloro
- Department of Haematology, Sydney Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead, New South Wales, Australia.,Faculty of Science and Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia
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Wieland I, Diekmann F, Carlens J, Hinze L, Lambeck K, Jack T, Hansmann G. Acquired von Willebrand syndrome (AVWS) type 2, characterized by decreased high molecular weight multimers, is common in children with severe pulmonary hypertension (PH). Front Pediatr 2022; 10:1012738. [PMID: 36452355 PMCID: PMC9701817 DOI: 10.3389/fped.2022.1012738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/14/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Emerging evidence suggests that increased degradation of von Willebrand factor and decrease in high molecular weight multimers occurs in patients with pulmonary hypertension (PH). However, the link between acquired von Willebrand Syndrome (AVWS) type 2 and PH remains poorly understood. MATERIAL AND METHODS We retrospectively evaluated the charts of 20 children with PH who underwent bilateral lung transplantation (LuTx) between 2013 and 2022. Von Willebrand variables were determined in 14 of these patients; 11 patients had complete diagnostics including multimer analysis. RESULTS We confirmed AVWS in 82% of the children studied (9 of 11 patients by multimer analysis). The two remaining patients had suspected AVWS type 2 because of a VWF:Ac/VWF:Ag ratio of <0.7. Platelet dysfunction or suspicion of VWD type 1 were found in two separate patients. All but one of the 14 children with severe PH had a coagulation disorder. Most patients (9 proven, 2 suspected) had AVWS type 2. Notably, 3 of 5 patients (60%) with normal VWF:Ac/VWF:Ag ratio >0.7 had abnormal VWF multimers, indicating AVWS type 2. Hemostatic complications were observed in 4 of 12 (33%) patients with VWS and 3 of 6 (50%) patients without diagnostics and therapy. CONCLUSION For children with moderate to severe PH, we recommend systematic analysis of von Willebrand variables, including multimer analysis, PFA-100 and platelet function testing. Awareness of the diagnosis "AVWS" and adequate therapy may help to prevent these patients from bleeding complications in case of surgical interventions or trauma.
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Affiliation(s)
- Ivonne Wieland
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Franziska Diekmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
| | - Julia Carlens
- Department of Pediatric Pulmonology, Allergology, and Neonatology, Hannover Medical School, Hannover, Germany
| | - Laura Hinze
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Katharina Lambeck
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Thomas Jack
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
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