The patient was then discharged in a stable condition. Because he moved to another city a few weeks after hospital discharge, a repeat TG assay was not possible. A telephone interview conducted 6 months later revealed that he did not experience any clinically obvious clotting abnormality again. In our patient, treatment with IVIG led to a normalization of hemostasis as confirmed by the TG assay, the disappearance of FV inhibitor, and the rise in FV activity. IVIG was given on the basis of its reported efficacy in patients with acquired hemo-philia A. However, a spontaneous recovery cannot be ruled out with certainty. The amount of thrombin generated, the lag phase and the time to thrombin peak are influenced by FV, as FV is part of every step in the process of TG [4]. Platelet FV rather than plasma FV plays a significant role in the amplification phase of coagulation. FV inhibitor leads to an impaired initiation phase, and this in turn results in impaired platelet activation. On the other hand, FV on the surface of activated platelets becomes neutraliszed by FV inhibitor, which leads to a reduction in prothrombinase activity and thrombin burst. The amount of FV needed to produce an adequate thrombin burst is still unclear. In our patient, minimal changes in FV activity from 7.4% to 8.6% led to a considerable increase in thrombin formation. Higher concentrations of FV did not result in any further increase in ETP, but did result in further reductions in the lag phase and the time to peak. Al Dieri et al. [5] observed no severe impairment in ETP at FV levels of 2% in patients with congenital FV deficiency. However, they used much higher TF concentrations (15 pM) in their assay. Therefore, their data are hardly comparable to ours. Furthermore , a measurable amount of the coagulation factor in the presence of an acquired autologous inhibitor may not necessarily correlate with its hemostatic function. Studies in patients with acquired autoantibody hemophilia A have shown that the inactivation has a type II pattern, with some residual FVIII activity being identifiable even after incubation at high concentrations of antibody. The presence of the inhibitor rather than the measurable coagulation factor activity is thus important in assessing the hemostatic state. In conclusion, the TG assay could be useful for monitoring hemostatic changes in patients with FV deficiency due to an inhibitor. However, there are issues of standardization to be dealt with. Clinical correlation with TG cutoff values is also lacking. These issues have to be addressed before the assay can be used in clinical routine practice. Disclosure of Conflict of Interests The authors state that they have no conflict of interest. References 1 Favaloro EJ, Posen J, Ramakrishna R, Soltani S, McRae S, Just S, Aboud M, Low J, Gemmell R, Kershaw G, Coleman R, Dean M. Factor V inhibitors: rare or not so uncommon? A multi-laboratory investigation Blood Coagul Fibrinolysis 2004; 15: 637-47. 2 Streiff MB, Ness PM. Acquired FV inhibitors: a needless iatrogenic compl...