FX is the most important activator of prothrombin. 1 Missense mutations contribute to nearly 80% of the mutations causing the deficiency. 2 FX deficiency can produce variable bleeding phenotypes depending on the severity of deficiency. Accordingly, the patients were classified to have a severe, moderate or mild disease if they have FX coagulant activity (FX:C) levels of <1%, 1%-5% and 5%-10% respectively. 1 The National Organization for Rare Disorders (NORD) defines mild disease as 40% or more, moderate disease as 10%-40% and severe disease as 10% or less of FX:C. While mucocutaneous bleeding is the most common type of bleeding, haemarthrosis, postoperative bleeding, central nervous system bleeding, menorrhagia and gastrointestinal bleeding are not uncommon presentations. 1

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Background: Intestinal lymphocytes are the main reservoir of adenovirus (ADV) and, fecal shedding of ADV is often the first sign of loss of immune control of ADV. We therefore sought to determine the role of fecal adenoviral kinetics in predicting adenoviremia and survival outcomes following haematopietic cell transplantation (HCT). Patients and methods: A total of 376 recipients undergoing allogeneic HCT from February 2003 to September 2016 were screened for blood ADV using an ADV PCR until immunerecovery and cessation of immunosuppression. Patients with diarrhea were tested for fecal ADV and if fecal PCR was positive weekly fecal PCRs were performed. Results: ADV was detected in a total of 155 patients. Fecal ADV was positive in 151 (40%) and adenoviremia was detected in 55 (14.5%) transplant recipients. Fifty-one of 55 patients with adenoviremia were tested for fecal PCR and all 51 patients had positive fecal PCR. Median time to detection of fecal ADV was 11 days (IQR: 0 to 37) and median time to detection of adenoviremia was 25 days (IQR: −3 to 42). Forty patients were symptomatic with diarrhea prior to adenoviremia and had positive fecal PCR before the onset of adenoviremia. In these forty patients, median time from detection of ADV in the feces to viremia was 11 days (IQR: 1 to 25). We found linear relationship between peak blood PCR and peak fecal PCR before dissemination to blood (Figure 1). A threshold ADV level of 4.9 log10 copies/gm of feces pre

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