PMID- 9201145
OWN - NLM
STAT- MEDLINE
DCOM- 19970717
LR  - 20190914
IS  - 1077-4114 (Print)
IS  - 1077-4114 (Linking)
VI  - 19
IP  - 3
DP  - 1997 May-Jun
TI  - Modulation of an acquired coagulation factor V inhibitor with intravenous immune 
      globulin.
PG  - 226-31
AB  - PURPOSE: We report that treatment of an immune mediated postoperative Factor V 
      (FV) deficiency with intravenous immune globulin (IVIg) resulted in serological 
      and clinical disappearance of the inhibitor. PATIENTS AND METHODS: A 9-year-old 
      girl was exposed to bovine thrombin during cardiovascular surgery and 
      subsequently developed severe, refractory hemorrhage caused by acquired FV 
      deficiency (FV activity < 5%). Despite blood product transfusions, hemorrhage 
      continued, and the patient was given IVIg, 400 mg/kg daily, for 9 day. RESULTS: 
      Prolonged clotting times immediately trended toward normal, and the hemorrhage 
      ceased by the fifth IVIg treatment day, concomitant with increasing plasma FV 
      activity and disappearance of human FV inhibitor activity. The patient's plasma 
      initially had a much higher inhibitor titer against bovine FV (122-215 Bethesda 
      units) than against human FV (3-4 Bethesda units). Circulating antibodies (IgM 
      and IgG) to bovine and human thrombin and FV were detected by enzyme-linked 
      immunosorbent assay (ELISA). After completion of IVIg treatment, IgG antibodies 
      to bovine FV and thrombin persisted, as did high-titer inhibition of bovine FV, 
      whereas the subpopulation of IgG and IgM antibodies reactive with human FV were 
      undetectable. CONCLUSIONS: The inhibitor likely developed from a heterogenetic 
      immune response to bovine FV contaminating the topical thrombin preparation used 
      during surgery. To our knowledge, this is the first demonstration of 
      immunological clearance of an acquired FV antibody associated with the use of 
      IVIg. The data suggest an antiidiotypic mechanism of IVIg in modulating clearance 
      of antihuman FV antibodies.
FAU - Tarantino, M D
AU  - Tarantino MD
AD  - Division of Pediatric Hematology-Oncology, University of Louisville School of 
      Medicine, KY 40202, USA.
FAU - Ross, M P
AU  - Ross MP
FAU - Daniels, T M
AU  - Daniels TM
FAU - Nichols, W L
AU  - Nichols WL
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - J Pediatr Hematol Oncol
JT  - Journal of pediatric hematology/oncology
JID - 9505928
RN  - 0 (Antibodies)
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 9001-24-5 (Factor V)
RN  - EC 3.4.21.5 (Thrombin)
SB  - IM
MH  - Antibodies/analysis
MH  - *Cardiac Surgical Procedures
MH  - Child
MH  - Cross Reactions
MH  - Factor V/*antagonists & inhibitors
MH  - Factor V Deficiency/*chemically induced/*therapy
MH  - Female
MH  - Hemorrhage/etiology
MH  - Humans
MH  - Immunoglobulins, Intravenous/administration & dosage/*therapeutic use
MH  - Partial Thromboplastin Time
MH  - Postoperative Complications/blood/*chemically induced/*therapy
MH  - Thrombin/*adverse effects/immunology
EDAT- 1997/05/01 00:00
MHDA- 1997/05/01 00:01
CRDT- 1997/05/01 00:00
PHST- 1997/05/01 00:00 [pubmed]
PHST- 1997/05/01 00:01 [medline]
PHST- 1997/05/01 00:00 [entrez]
AID - 10.1097/00043426-199705000-00009 [doi]
PST - ppublish
SO  - J Pediatr Hematol Oncol. 1997 May-Jun;19(3):226-31. doi: 
      10.1097/00043426-199705000-00009.