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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Severe serous cavity bleeding caused by acquired factor V deficiency associated with lymphatic leakage in a hemodialysis patient: A case report
Wen-Bo Zhao, Yan-Ru Chen, Dan Luo, Hong-Chun Lin, Bing Long, Zhen-Yu Wu, Hui Peng
Wen-Bo Zhao, Yan-Ru Chen, Hong-Chun Lin, Department of Nephrology,The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
Dan Luo, Hui Peng, Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
Bing Long, Department of Hematology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
Zhen-Yu Wu, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
Author contributions: Zhao WB was the patient’s renal physician, reviewed the literature and contributed to manuscript drafting; Chen YR reviewed the literature and contributed to manuscript drafting; Luo D and Lin HC performed the interpretation and contributed to manuscript drafting; Wu ZY analyzed data and interpreted the findings of statistical analysis; Long B performed the blood diseases consultation, reviewed the literature and drafted the manuscript; Peng H was responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2013), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hui Peng, MD, PhD, Professor, Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China. pengh@mail.susu.edu.cn
Telephone: +86-20-85252865
Received: April 24, 2019
Peer-review started: May 8, 2019
First decision: May 31, 2019
Revised: July 30, 2019
Accepted: August 20, 2019
Article in press: August 20, 2019
Published online: September 6, 2019
BACKGROUND
Acquired factor V deficiency is a rare secondary hemorrhagic disease, which can lead to a severe bleeding disorder.
CASE SUMMARY
We report a 47-year-old hemodialysis patient who presented with severe hemorrhagic pleural effusion and hemorrhagic pericardial effusion associated with lymphatic leakage. The laboratory examination revealed decreased factor V activity (2% of population average value). With decreased lymphatic leakage, factor V activity increased (to 46%). Lymph drainage correlated with prothrombin time and active partial thrombin time. The cause of the disease favored an acquired disease. The common causes which trigger factor V inhibitors were excluded. An inhibitor was not detected. It is possible that there was a clotting factor inhibitor leaking with the lymph in the drainage. Inhibitor production may be due to immune dysfunction caused by persistent lymphatic drainage, or that coagulation inhibitors were produced, drained with the lymph, and partly cleared by hemodialysis.
CONCLUSION
In this case, we have firstly reported factor V deficiency associated with lymphatic leakage in a hemodialysis patient.
Core tip: Acquired factor V deficiency (AFVD) is a rare secondary hemorrhagic disease, which can lead to serious bleeding disorder. We report a new AVFD case of a hemodialysis patient with severe serous cavity hemorrhagic effusion, associated with potentially secondary to lymphatic leakage, and factor V inhibitor detection is negative. This is the first report regarding the association between coagulation factor V deficiency and lymphatic drainage in hemodialysis patient of chronic kidney disease patient. Careful follow-up of blood coagulation is needed in patients under the treatment of lymphatic drainage.
