Hemostatic Defect due to Acquired Circulating Inhibitors against Lipid Procoagulant and Factor VIII

Liberto Pechet; L Michael Snyder; Carolyn Chesney; Robert W. Colman

doi:10.1055/s-0038-1647676

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 1974; 32(01): 090-104
DOI: 10.1055/s-0038-1647676

Original Article

Schattauer GmbH

Hemostatic Defect due to Acquired Circulating Inhibitors against Lipid Procoagulant and Factor VIII^[*]

Authors

Liberto Pechet

¹Department of Medicine, Division of Hematology, St. Vincent Hospital, Worcester, Massachusetts 01610 and the Department of Medicine, Hematology Unit, Massachusetts General Hospital, Boston, Massachusetts 02114
L Michael Snyder

¹Department of Medicine, Division of Hematology, St. Vincent Hospital, Worcester, Massachusetts 01610 and the Department of Medicine, Hematology Unit, Massachusetts General Hospital, Boston, Massachusetts 02114
Carolyn Chesney

¹Department of Medicine, Division of Hematology, St. Vincent Hospital, Worcester, Massachusetts 01610 and the Department of Medicine, Hematology Unit, Massachusetts General Hospital, Boston, Massachusetts 02114
Robert W. Colman⁺

¹Department of Medicine, Division of Hematology, St. Vincent Hospital, Worcester, Massachusetts 01610 and the Department of Medicine, Hematology Unit, Massachusetts General Hospital, Boston, Massachusetts 02114

Abstract

Summary

An 85 year old woman was studied because of severe bleeding. Acquired inhibitors to factor VIII and to phospholipid procoagulants were demonstrated. Platelet factor 3 (Pf3) assay was prolonged with both kaolin and Russell’s Viper Venom (Stypven^E). It was normal with patient’s washed platelets and normal plasma, but abnormal when normal platelets were incubated with patient’s plasma. The inibitor also blocked the coagulant action of Bell and Alton thromboplastin, inosithin, phosphatidyl ethanolamine and phosphatidyl choline, but not that of tissue thromboplastin or cardiolipin. All other platelet functions were normal. The inhibitors were purified by A1 (OH₃) absorption, heating at 56°, precipitation by 50% ammonium sulfate, followed by dialysis and DEAE-cellulose chromatography. A partial separation of the two inhibitors was achieved.

Cyclophosphamide treatment resulted in cessation of bleeding and disappearance of the inhibitors. This seems to be the first instance of an acquired circulating inhibitor specifically directed against phospholipid procoagulants in a patient who also had an inhibitor to Factor VIII.

Full Text

References

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Hemostatic Defect due to Acquired Circulating Inhibitors against Lipid Procoagulant and Factor VIII[*]

Authors

Hemostatic Defect due to Acquired Circulating Inhibitors against Lipid Procoagulant and Factor VIII^[*]