Transient lupus anticoagulant associated with hypoprothrombinemia and Factor XII deficiency following adenovirus infection

Jaeger, Ulrich; Kapiotis, Stylianos; Pabinger, Ingrid; Puchhammer, E; Kyrle, Paul A.; Lechner, Klaus

doi:10.1007/bf01788133

Cited by 64 publications

(48 citation statements)

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“…The prevalence of transient and asymptomatic antiphospholipid antibodies (aPL) and/or LAC are more common in children than in adults (39)(40)(41)(42)(43)(44), which can be partly ascribed to acquired infections (39)(40)(41)(42)(43)(44)(45)(46)(47)(48). Since children suffer from infections more often than adults, this might explain why children had a much higher prevalence for LAC than adults (42), especially in early childhood (43,44).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Age-associated developmental changes in the activated partial thromboplastin time (APTT) and causes of prolonged APTT values in healthy Chinese children

Lai

Yan

et al. 2009

Clinical Chemistry and Laboratory Medicine

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Section: Discussionmentioning

confidence: 99%

“…A frequent association of transient aPL and/or LAC with low factor XII exists (45,48,49). This suggests that aPL and/or LAC play a role in the pathogenesis of decreased factor XII in children.…”

Section: Discussionmentioning

confidence: 99%

Age-associated developmental changes in the activated partial thromboplastin time (APTT) and causes of prolonged APTT values in healthy Chinese children

Lai

Yan

et al. 2009

Clinical Chemistry and Laboratory Medicine

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“…In addition there have been cases with acquired hypoprothrombinaemia and bleeding, most often in combination with LA [5,6,19,21,31,[8][9][10][11][12]26,32]. Haemorrhagic LA syndrome is rare, less than 30 patients are described in the medical literature, and it has been attributed to increased clearance of prothrombin caused by non-neutralizing antiprothrombin antibodies.…”

Section: Introductionmentioning

confidence: 99%

“…Haemorrhagic LA syndrome is rare, less than 30 patients are described in the medical literature, and it has been attributed to increased clearance of prothrombin caused by non-neutralizing antiprothrombin antibodies. Their signs and symptoms have varied from mild bleeding such as bruising and haematoma to severe gum bleeding, epistaxis and in two cases haemarthrosis [5,6,19,21,31,[8][9][10][11][12]26,32].…”

Section: Introductionmentioning

confidence: 99%

Lupus anticoagulants in two children—bleeding due to nonphospholipid-dependent antiprothrombin antibodies

Knobe

Tedgård

et al. 2012

Eur J Pediatr

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Lupus anticoagulants in two children-bleeding due to nonphospholipid-dependent antiprothrombin antibodies.Knobe, Karin; Tedgård, Ulf; Ek, Torben; Sandström, Per-Erik; Hillarp, Andreas Link to publication Citation for published version (APA): Knobe, K., Tedgård, U., Ek, T., Sandström, P-E., & Hillarp, A. (2012). Lupus anticoagulants in two childrenbleeding due to nonphospholipid-dependent antiprothrombin antibodies. European Journal of Pediatrics, 171(9), 1383-1387. DOI: 10.1007/s00431-012-1737-1General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal AbstractWe describe two children with significant bleeding; one with multiple ecchymoses and the other with scrotal bleeding. In both patients, the activated partial thromboplastin time (APTT) was prolonged with positivity for lupus anticoagulants (LA). However, the Owren prothrombin time (PT), usually insensitive for LA, was also prolonged. Presence of LA is associated with diverse clinical manifestations, most patients being asymptomatic while others present venous or arterial thrombosis. Bleeding in conjunction with lupus anticoagulants is rare and it is unusual to see prolongation of the Owren PT assay due to LA. An extended laboratory investigation of one of the patient's plasma revealed not only LA but also a specific non-phospholipid dependent anti-prothrombin antibody causing an acquired hypoprothrombinaemia. Conclusion: It is likely that the low prothrombin activity and not the LA caused the bleeding. The bleeding signs and symptoms in both patients subsided when the PT was normalised although the prolonged APTT and the LA remained.

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“…APTT prolongation and subacute thyroiditis occurred virtually simultaneously suggesting an association between a viral infection and APTT prolongation; recently, lupus anticoagulant associated with hypoprothrombinemia and factor XII deficiency following an adenovirus infection was reported. 17 This patient experienced various infectious episodes, CMV pneumonitis with markedly high levels of CMV antigemia and subacute thyroiditis after her BMT. CD4 ϩ cell recovery after BMT was incomplete, even after 1 year.…”

Section: Discussionmentioning

confidence: 92%

Cytomegalovirus pneumonitis, activated prothrombin time prolongation and subacute thyroiditis after unrelated allogeneic bone marrow transplantation

Kawano

Muroi

Akioka

et al. 2000

Bone Marrow Transplant

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Summary:A 22-year-old female with acute myeloid leukemia (AML) in complete remission received a conditioning regimen containing antithymocyte globulin for an unrelated bone marrow transplant (BMT). After BMT, the patient suffered from cytomegalovirus (CMV) pneumonitis with markedly high levels of CMV antigenemia, activated prothrombin time (APTT) prolongation, and subacute thyroiditis. Recovery of CD4؉ cells was delayed as long as 1 year after BMT. An association between these three episodes and viral infection due to the delayed recovery of CD4 ؉ cells is suggested. Bone Marrow Transplantation (2000) 26, 1347-1349. Keywords: bone marrow transplantation; antithymocyte globulin; viral infection; CD4 ϩ cells Viral infections are major causes of mortality and morbidity in patients who receive an allogeneic BMT. During the early and late post-transplant periods, herpes and other viruses cause localized and systemic disease. Of these viruses, CMV infection is the most common, and patients may present with pneumonitis, enteritis or myelosuppression. 1-4 CMV reactivation can be measured by detecting the CMV pp65 antigen (CMV antigenemia). 5,6We describe a patient with AML who received an unrelated allogeneic BMT and developed CMV pneumonitis, APTT prolongation and subacute thyroiditis. CMV pneumonitis and subacute thyroiditis were successfully treated with ganciclovir and prednisolone, respectively. Case reportA 22-year-old female with AML (FAB M6) in first complete remission underwent an allogeneic BMT. The patient was seropositive for CMV and Epstein-Barr (EB) viruses and had normal coagulation parameters. On 5 June 1997, she received an allogeneic BMT from an unrelated HLAidentical male donor (A2, A24, B7, B54, Cw1, Cw7, DR1 and DR4). Conditioning was with total body irradiation at 1200 cGy in six fractions from days Ϫ9 to Ϫ7; cytarabine, 1000 mg/m 2 twice a day from days Ϫ6 to Ϫ4; and cyclophosphamide, 60 mg/kg on days Ϫ3 and Ϫ2. In addition, 2.5 mg/kg of antithymocyte globulin (ATG) was administered from days Ϫ5 to Ϫ2. On day 0, 4.1 ϫ 10 8 /kg of untreated nucleated bone marrow cells was infused. Graftversus-host disease (GVHD) prophylaxis was short-term methotrexate and cyclosporine. CMV hyperimmuneglobulin was given at a dose of 12.5 g every 2 weeks to prevent CMV infection, between days ϩ7 and ϩ120. Granulocyte colony-stimulating factor was given from day ϩ1.Regimen-related toxicities were mild; the patient complained of slight nausea and diarrhea. Bone marrow engraftment was confirmed on day ϩ15 using karyotypic and fluorescence in situ hybridization analyses. On day ϩ54, the patient developed a dry cough and low-grade fever. Computed tomography of the chest showed pneumonitis in both lungs. At this time, markedly high levels of CMV antigenemia were noticed (Figure 1). CMV pneumonitis was diagnosed and 5 mg/kg of ganciclovir twice a day was initiated. Following the therapy, CMV antigenemia levels dropped and the interstitial infiltrates in both lungs resolved. No acute GVHD occurred. On day ϩ118, she complaine...

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Transient lupus anticoagulant associated with hypoprothrombinemia and Factor XII deficiency following adenovirus infection

Cited by 64 publications

References 19 publications

Age-associated developmental changes in the activated partial thromboplastin time (APTT) and causes of prolonged APTT values in healthy Chinese children

Age-associated developmental changes in the activated partial thromboplastin time (APTT) and causes of prolonged APTT values in healthy Chinese children

Lupus anticoagulants in two children—bleeding due to nonphospholipid-dependent antiprothrombin antibodies

Cytomegalovirus pneumonitis, activated prothrombin time prolongation and subacute thyroiditis after unrelated allogeneic bone marrow transplantation

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