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Acquisition of factor V inhibitor is a rare event. The inhibitor most frequently encountered in clinical practice is directed against factor VIII. In a recent review of the literature, Streiff and Ness1 found 126 published cases of factor V inhibitor. The inhibitor emerged after major surgery, haemostatic therapy with bovine thrombin, malignancies, autoimmune disorders, blood transfusion, antibiotic therapy, or for unknown reasons. We report the emergence of factor V inhibitor in a cirrhotic patient receiving valproic acid for seizure control.
A 50 year old man treated for alcoholic cirrhosis was admitted for epistaxis. He had no history of autoimmune disorders or blood transfusion. For three years he had been taking valproic acid 1 g/day orally for seizures, and propranolol 60 mg/day. On admission, prothrombin level was 5% of control, factor V was 1%, and factor II was 49%. Two months previously prothrombin level had been 83% of control on two occasions one month apart. Physical examination showed compensated cirrhosis. Epistaxis was linked to telangiectasia and was controlled by meshing …
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Conflict of interest: None declared.