Abstract
Acquired factor V inhibitor is a rare bleeding disorder and is caused by many factors. This disease is diagnosed on the basis of the results of mixing studies, absence of a lupus anticoagulant, results of coagulation factor assays, and the results of the Bethesda assay that measures the level of factor V inhibitor. The treatment for acquired factor V inhibitor is transfusion of fresh frozen plasma and platelet concentrate to promote hemostasis and administration of an immunosuppressant to eliminate factor V inhibitor. In the case that this treatment is ineffective, plasma exchange is applied to the patients. We experienced the case of a 55-year-old man with drug-resistant acquired factor V inhibitor for whom plasma exchange was performed 9 times. He complained of hematoma, which increased in size over time, and showed cardiac tamponade. Treatment with high-dose methylprednisolone and rituximab was ineffective. Thus, plasma exchange was applied in this case. Despite 9 sessions of therapy with an immunosuppressant and fresh frozen plasma as well as transfusion of platelet concentrate, the bleeding was unmanageable. Our experience with this case suggests that in some cases of acquired factor V inhibitor, bleeding cannot be managed even with plasma exchange, and hence, other therapies should be considered.
