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Sanaz Ghafouri, Matthew Rettig, Kanwarpal S. Kahlon
(Departmernt of Hematology Oncology, University of California Los Angeles (UCLA) Medical Center, Los Angeles, CA, USA)
Am J Case Rep 2020; 21:e926728
Coagulation abnormalities are frequently encountered in patients with coronavirus disease 2019 (COVID-19), especially in those with more severe disease. These hematologic abnormalities are suspected to occur in the context of underlying immune dysregulation and endothelial dysfunction. Elevated D-dimer levels, COVID-19-associated coagulopathy (CAC), disseminated intravascular coagulation (DIC), and positive lupus anticoagulants are the most common findings to date. Current guidelines suggest that all patients with COVID-19 should receive pharmacologic thromboprophylaxis.
CASE REPORT: An 89-year-old man with a medical history of hypertension, type 2 diabetes, and advanced prostate cancer in remission presented with generalized weakness. At our center, a reverse transcription-polymerase chain reaction test was positive for severe acute respiratory syndrome coronavirus 2, but the patient did not have symptoms of COVID-19. He was also found to have a prolonged activated partial thromboplastin time, secondary to both a high titer of factor VIII inhibitor and a lupus anticoagulant. He eventually developed respiratory compromise, during which his disease manifested as a bleeding rather than a prothrombotic state.
CONCLUSIONS: This report highlights the importance of a comprehensive evaluation of prolonged partial thromboplastin time, rather than making an assumption based on a positive lupus anticoagulant result. In the case presented, the concomitant factor VIII inhibitor caused the patient to have a greater bleeding tendency. It is imperative that physicians balance the risk of bleeding and clotting in patients with COVID-19 because patients seem to have varying presentations based on disease severity and level of immune dysregulation.
Keywords: COVID-19, Factor VIII, Hemophilia A, Lupus Coagulation Inhibitor