Acquired Factor V Inhibitor After Antibiotic Therapy: A Clinical Case Report and Review of the Literature

Acquired factor V inhibitor (aFVi) is an exceptionally rare hematologic condition that can range from incidental laboratory abnormalities to life-threatening hemorrhage. Bovine thrombin was formerly the most common cause of this condition; however, the decreased use of bovine thrombin in surgical pr...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2020-07, Vol.12 (7)
Main Authors: Chartier, Alexander R, Hillert, Conor J, Gill, Harpreet, Jha, Pinky
Format: Article
Language:English
Subjects:
Antibiotics
Asymptomatic
Autoimmune diseases
Blood
Case reports
Epistaxis
FDA approval
Hematology
Hemoglobin
Hospitals
Laboratories
Pulmonary embolisms
Vital signs
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Summary:Acquired factor V inhibitor (aFVi) is an exceptionally rare hematologic condition that can range from incidental laboratory abnormalities to life-threatening hemorrhage. Bovine thrombin was formerly the most common cause of this condition; however, the decreased use of bovine thrombin in surgical procedures has led to a shift in the cause of aFVi toward antibiotic use and malignancies. Here we present a case of an 80-year-old Caucasian female on long-term warfarin therapy who presented with epistaxis and an elevated international normalized ratio, and a history of cephalosporin antibiotic use. We review the published literature beginning in 2016 to identify the evolving causes of aFVi. Additionally, we propose that stress-mediated immune regulation may contribute to antibody formation, preventing the interaction between factor V and the damaged phospholipid membranes. This case highlights the evolving causes of aFVi and should prompt physicians to consider this diagnosis in coagulopathies that do not correct with traditional therapies.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.9481