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Blood, 15 January 2009, Vol. 113, No. 3, pp. 723-725.
Prepublished online as a Blood First Edition Paper on October 27, 2008; DOI 10.1182/blood-2008-09-179333.


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THROMBOSIS AND HEMOSTASIS

Brief report

Severe bleeding complications caused by an autoantibody against the B subunit of plasma factor XIII: a novel form of acquired factor XIII deficiency

Éva Ajzner1, Ágota Schlammadinger2, Adrienne Kerényi3, Zsuzsanna Bereczky1, Éva Katona1, Gizella Haramura1, Zoltán Boda2, and László Muszbek1,4

1 Clinical Research Center, 2 2nd Department of Medicine, Hemostasis Division, 3 Department of Clinical Biochemisty and Molecular Pathology, and 4 Thrombosis, Haemostasis and Vascular Biology Research Group of the Hungarian Academy of Sciences, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary

Acquired factor XIII (FXIII) deficiency due to autoantibody against FXIII is a very rare severe hemorrhagic diathesis. Antibodies directed against the A subunit of FXIII, which interfere with different functions of FXIII, have been described. Here, for the first time, we report an autoantibody against the B subunit of FXIII (FXIII-B) that caused life-threatening bleeding in a patient with systemic lupus erythematosus. FXIII activity, FXIII-A2B2 complex, and individual FXIII subunits were undetectable in the plasma, whereas platelet FXIII activity and antigen were normal. Neither FXIII activation nor its activity was inhibited by the antibody, which bound to structural epitope(s) on both free and complexed FXIII-B. The autoantibody highly accelerated the elimination of FXIII from the circulation. FXIII supplementation combined with immunosuppressive therapy, plasmapheresis, immunoglobulin, and anti-CD20 treatment resulted in the patient's recovery. FXIII levels returned to around 20% at discharge and after gradual increase the levels stabilized above 50%.


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Anesth. Analg.Home page
C. Jambor, V. Reul, T. W. Schnider, P. Degiacomi, H. Metzner, and W. C. Korte
In Vitro Inhibition of Factor XIII Retards Clot Formation, Reduces Clot Firmness, and Increases Fibrinolytic Effects in Whole Blood
Anesth. Analg., October 1, 2009; 109(4): 1023 - 1028.
[Abstract] [Full Text] [PDF]



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