暴露于局部牛凝血酶后的两个儿童的牛和人因子V抗体的发展。

S J Israels, E D Israels
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引用次数: 56

摘要

目的:获得性凝血因子抑制剂在儿科患者中罕见。暴露于局部牛凝血酶是一个危险因素发展抑制剂在成人心脏手术患者。我们报告了两名儿科患者,他们在接触含有牛凝血酶的纤维蛋白胶后产生了牛和人因子V的抑制剂。患者与方法:研究2例心脏手术后患者,年龄分别为3岁半和10个月。1例患者出现临床出血。进行凝血因子测定和抑制剂研究。结果:两例患者均存在牛因子V循环抑制剂,1例患者存在人因子V循环抑制剂。牛因子V的抑制干扰了使用含有牛因子V的商业底物进行因子VIII活性的标准测定,导致虚假的因子VIII缺乏。在一个病人,牛凝血酶抑制剂也被确定。一名患者的人因子V活性抑制可能导致临床出血。结论:暴露于局部牛凝血酶的儿科患者,特别是在心脏手术的背景下,有牛凝血酶和v因子抗体产生的风险,这也可能导致其他凝血因子明显但虚假的消耗。这些抗体可能与人凝血因子,特别是V因子发生交叉反应,导致临床出血。
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Development of antibodies to bovine and human factor V in two children after exposure to topical bovine thrombin.

Purpose: Acquired inhibitors to coagulation factors are rare in pediatric patients. Exposure to topical bovine thrombin is a risk factor for the development of inhibitors in adult cardiac surgery patients. We report two pediatric patients who developed inhibitors to bovine and human factor V after exposure to fibrin glue containing bovine thrombin.

Patients and methods: The two patients, ages 3 1/2 years and 10 months, were studied after cardiac surgery. One patient had clinical bleeding. Coagulation factor assays and inhibitor studies were performed.

Results: The presence of a circulating inhibitor to bovine factor V was observed in both patients and to human factor V in one patient. The inhibition of bovine factor V interfered with standard assays for factor VIII activity using a commercial substrate fortified with bovine factor V resulting in spurious factor VIII deficiency. In one patient, an inhibitor of bovine thrombin was also identified. The inhibition of human factor V activity in one patient may have contributed to clinical bleeding.

Conclusions: Pediatric patients exposed to topical bovine thrombin, particularly in the setting of cardiac surgery, are at risk for the development of antibodies to bovine thrombin and factor V. This may also result in apparent but spurious depletion of other coagulation factors. These antibodies may cross-react with human coagulation factors, particularly factor V, resulting in clinical bleeding.

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