Acquired coagulation factor inhibitors in children after topical bovine thrombin exposure

Pediatric Blood & Cancer
William J SavageClifford M Takemoto

Abstract

Acquired inhibitors of coagulation factors, particularly to factor V (FV) and thrombin, after topical bovine thrombin exposure may result in clinically important coagulopathies. While bovine thrombin is commonly used in pediatric patients for surgical hemostasis, the reported cases of acquired inhibitors in children are few. We report two cases of children who developed factor inhibitors after bovine thrombin exposure. One child developed a FV inhibitor at 3 months of age after exposure to bovine thrombin during cardiac surgery. The inhibitor resolved with intravenous immunoglobulin (IVIG) and steroids. The other child developed concomitant FV and bovine thrombin inhibitors after cardiac surgery at age 11 years. The presence of these inhibitors complicated post-operative anti-coagulation management, but the inhibitors were transient. In addition to these two cases, we identified all the pediatric patients with bovine thrombin-induced inhibitors who were reported in the world's literature, and reviewed their clinical characteristics. These cases underscore the fact that bovine thrombin can be antigenic in infants and children and can result in significant coagulopathies.

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Citations

Sep 8, 2009·Patient Safety in Surgery·Christopher Lomax
May 26, 2009·Patient Safety in Surgery·Paul NessUNKNOWN Recognition, Evaluation and Treatment of Acquired Coagulopathy Consensus (RETACC) Panel
Aug 27, 2009·Biologics : Targets & Therapy·Wesley K Lew, Fred A Weaver
Jun 30, 2009·Pharmacotherapy·Christopher Lomax, Oren Traub
Jun 30, 2009·Pharmacotherapy·Joseph J Naoum
Jan 30, 2014·Pediatric Blood & Cancer·Kaitlyn ShawBruce C Carleton
Jan 16, 2014·Autoimmunity Reviews·Hsiu-Hao Chang, Bor-Luen Chiang
Jun 16, 2010·Clinical and Applied Thrombosis/hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis· He ZhuJawed Fareed
Feb 26, 2010·Journal of Burn Care & Research : Official Publication of the American Burn Association·Kevin N FosterDaniel M Caruso
Nov 25, 2006·Hematology·Lawrence L K Leung

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