2023 Volume 56 Issue 1 Pages 29-36
In X-3 years, a woman in her 70s was started on hemodialysis. Her PT and APTT were 11 and 24 sec, respectively, at that time. Nafamostat mesylate had been used during dialysis as of October X-1, after she developed gastric antral vascular ectasia. She was treated with antimicrobial agents for fever and cough in February X, but did not improve. She was consequently admitted to our facility. Aside from pneumonia, abnormal coagulation was observed (PT：54 sec, APTT：215 sec). Coagulation factor V activity was significantly reduced, and factor V inhibitor and antiFV autoantibodies were detected in the blood, indicating the presence of acquired factor V inhibitor. The patient showed a right temporal lobe hemorrhage on the 33rd day of hospitalization, and 10 units of platelet concentrate were transfused. On the 34th day, oral prednisolone at 20 mg/day was initiated. On the 37th day, PT and APTT times were reduced to 11 and 19 sec, respectively. The factor V inhibitor became negative on the 57th day. Although this disease is extremely rare, it can occasionally cause severe bleeding symptoms. As a result, it is critical to make an accurate diagnosis and assess the treatment options. When abnormal coagulation is observed in a hemodialysis patient, bleeding symptoms should be examined and investigated as promptly as possible, keeping this disease in mind.
