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Development of antibodies to thrombin and factor V with recurrent bleeding
in a patient exposed to topical bovine thrombin
JL Zehnder and LL Leung
Department of Medicine, Stanford University Medical Center, CA 94305.
A 65 year old patient who was exposed to topical bovine thrombin during
cardiac surgery developed markedly prolonged clotting times and a severe
bleeding diathesis. Mixing studies with normal plasma failed to correct the
clotting times. Platelet transfusions, immunosuppressive and
immunomodulatory therapies were ineffective, but plasmapheresis was
effective in decreasing clotting times and in the resolution of clinical
bleeding events. The patient's purified IgG reacted with bovine thrombin by
immunoblotting and enzyme-linked immunosorbent assay (ELISA). However, the
IgG reacted minimally with human thrombin. In view of the severe bleeding,
a coexisting inhibitor was sought. The patient's factor V activity was 1%
of normal and was not corrected by mixing with normal plasma, demonstrating
the presence of an inhibitor against factor V. The patient's IgG reacted
with both bovine and human factor V. Immunoblotting localized the site of
antibody binding to the light chain of activated bovine factor V.
Detectable amounts of bovine factor V were found in commercial bovine
thrombin preparations by ELISA. The data suggest that patients exposed to
topical bovine thrombin may develop antibodies to thrombin and factor V.
Anti-thrombin antibodies may mask coexisting factor V inhibitors
responsible for clinical bleeding.
Volume 76,
Issue 10,
pp. 2011-2016,
11/15/1990
Copyright © 1990 by The American Society of Hematology
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