Published online Sep 6, 2019. doi: 10.12998/wjcc.v7.i17.2556
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
Acquired factor V deficiency is a rare secondary hemorrhagic disease, which can lead to a severe bleeding disorder.
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.
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.