2014 Volume 5 Issue 1 Pages 85-87
Acquired factor V inhibitor often presents with life-threatening bleeding and it is difficult to determine the operable condition. Immunosuppressive therapy and plasma exchange (PE) are the recommended treatment, but the results remain unclear. Case: An 81 year-old man with severe burns (burn index 35) was operated on on day 7 for debridement and split thickness skin grafting. After the surgery, the international normalized ratio（INR）and the activated partial thromboplastin time (APTT) were elevated. We postponed the planned second skin graft because supplementation of vitamin K and fresh frozen plasma was unable to stop the coagulation disturbance. The inhibitor pattern on the cross mixing test and the coagulation factor V activity (＜3%) made us suspect the existence of factor 5 inhibitors. From day 19 we performed PE to remove the inhibitors. INR and APTT showed only a temporary improvement so on day 21 we administered prednisolone (PSL). Some days later, we received word that a test on day 18 had proved positive for FV inhibitor, thus giving us our definitive diagnosis. After the PSL dosage, INR and APTT improved only a little so we repeated the treatment. This time, the INR and APTT improved only temporarily. Conclusion: PE is not a curative therapy, so it is necessary to give careful attention to the indications and timing of PE therapy.
