抜歯後出血を契機に診断された先天性第Ⅴ因子欠乏症の1例

Blood coagulation factor V is a common factor involved in both intrinsic and extrinsic pathways of coagulation; its congenital deficiency is rare. We report a case of congenital factor V deficiency detected because of bleeding after tooth extraction. A 60-year-old man visited our department because...

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Published in日本口腔外科学会雑誌 Vol. 57; no. 5; pp. 279 - 283
Main Authors 薮田, 達雄, 葛城, 勝彦, 妙中, 泰之, 藤田, 茂之, 和田, 健, 森田, 展雄
Format Journal Article
LanguageJapanese
Published 社団法人 日本口腔外科学会 20.05.2011
Subjects
先天性第V因子欠乏症
後出血
抜歯
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ISSN0021-5163
2186-1579
DOI10.5794/jjoms.57.279

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Abstract Blood coagulation factor V is a common factor involved in both intrinsic and extrinsic pathways of coagulation; its congenital deficiency is rare. We report a case of congenital factor V deficiency detected because of bleeding after tooth extraction. A 60-year-old man visited our department because of continued bleeding after tooth extraction. We were able to stop the bleeding by local hemostatic measures. However, prothrombin time （PT） was found to be prolonged on a screening blood test. After further evaluation at the Department of Hematology/Oncology, prolongations of both PT and activated partial thromboplastin time （APTT） were confirmed, and the factor V activity was 4.7 ％, which is very low. After correction of the PT and APTT values by a cross-mixing test, the possibility of an acquired coagulation factor inhibitor was ruled out. The patient was then given a diagnosis of congenital factor V deficiency. He visited our department again to undergo extraction of the right upper first premolar. After consultation with the Department of Hematology/Oncology, tooth extraction was performed under local anesthesia concurrently with transfusion of fresh frozen plasma. Factor V activity was corrected to 22.3 ％ from 3.8 ％, and the PT and APTT values improved. Postoperative bleeding was controlled by local hemostatic measures using oxidized cellulose and a gingival pack.
AbstractList Blood coagulation factor V is a common factor involved in both intrinsic and extrinsic pathways of coagulation; its congenital deficiency is rare. We report a case of congenital factor V deficiency detected because of bleeding after tooth extraction. A 60-year-old man visited our department because of continued bleeding after tooth extraction. We were able to stop the bleeding by local hemostatic measures. However, prothrombin time （PT） was found to be prolonged on a screening blood test. After further evaluation at the Department of Hematology/Oncology, prolongations of both PT and activated partial thromboplastin time （APTT） were confirmed, and the factor V activity was 4.7 ％, which is very low. After correction of the PT and APTT values by a cross-mixing test, the possibility of an acquired coagulation factor inhibitor was ruled out. The patient was then given a diagnosis of congenital factor V deficiency. He visited our department again to undergo extraction of the right upper first premolar. After consultation with the Department of Hematology/Oncology, tooth extraction was performed under local anesthesia concurrently with transfusion of fresh frozen plasma. Factor V activity was corrected to 22.3 ％ from 3.8 ％, and the PT and APTT values improved. Postoperative bleeding was controlled by local hemostatic measures using oxidized cellulose and a gingival pack.
Author 薮田, 達雄
森田, 展雄
妙中, 泰之
藤田, 茂之
和田, 健
葛城, 勝彦
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References 8) 坂田好史, 三島秀雄, 他：先天性第Ⅴ因子欠乏症を伴う結腸癌の1例. 日消外会誌 36: 1626-1629　2003.
6) 宮川創平, 山内　宏, 他：卵巣出血により腹腔内大量出血を起こした先天性第Ⅴ因子欠乏症の1例. 産婦･新生児血液 9: 57-61 1985.
3) 篠澤圭子：先天性第Ⅴ因子欠乏症とその遺伝子変異. 日血栓止血会誌 16: 281-296 2005.
12) 真鍋隆宏, 大塚将秀：食道癌術後にみられ第V因子インヒビターによる凝固機能検査異常をきたした1例. ICU とCCU 23: 459-463 1999.
5) 須崎　真, 三田正明, 他：先天性第Ⅴ因子欠乏症に併発した腸腰筋血腫の1例. 画像診断 7: 333-335 1987.
14) 木村　裕, 新垣　晋, 他：先天性第V因子欠乏症患者の抜歯経験. 新潟歯会誌 12: 79-87 1982.
11) 清水郁夫, 市川直明, 他：複数の凝固因子活性低下を示した高力価の突発性後天性第V因子インヒビター. 臨血 49: 413-416 2008.
10) 矢島愛治, 鳥居　毅, 他：先天性第Ⅴ因子欠乏症に合併した尿管腫瘍. 臨泌 46: 341-343 1992.
13) 新谷憲治：後天性血友病の診断と治療. 吉岡　章監修；ヘモフィリア治療の最前線　血友病の診断と治療. 第1版, 医科学出版社, 東京, 2002, 94-99頁.
16) Joseph, C.F. and Margaret, H.: Nature of the defect in congenital factor Ⅴ deficiency: study in a patient with an acquired circulating anticoagulant. Blood 39: 751-758 1972.
2) 岸田邦雄, 小柳英樹：先天性第Ⅴ因子欠乏症. 小児科 MOOK 54: 113-118 1988.
7) 吉岡　章, 藤村吉博, 他：先天性第Ⅴ因子欠乏症（Parahemophilia）の1例 — 自験例と本邦報告例の文献的考察 —. 臨血 16: 953-962 1975.
4) 田崎哲典：輸血製剤の適正使用のために　輸血検査, 輸血管理はどのように行うべきか 血液製剤の使用指針　新鮮凍結血漿の適正使用. Med Technol 34: 1142-1148 2006.
15) 坪井徹洋, 新美直哉, 他：先天性第V因子欠乏症患者における抜歯の1例. 日口外誌 44: 1005-10071998.
1) Owren, P.A.: Parahemophilia: Hemorrhagic diathesis due to absence of a previously unknown clotting factor. Lancet 249: 446-448 1947.
9) 三上貞昭, 上田直子, 他：術前凝固スクリーニング異常により発見され, 子宮全摘出術を行った先天性第V因子欠乏症の1症例. 奈良医誌 42: 545-549 1991.
References_xml – reference: 1) Owren, P.A.: Parahemophilia: Hemorrhagic diathesis due to absence of a previously unknown clotting factor. Lancet 249: 446-448 1947.
– reference: 13) 新谷憲治：後天性血友病の診断と治療. 吉岡　章監修；ヘモフィリア治療の最前線　血友病の診断と治療. 第1版, 医科学出版社, 東京, 2002, 94-99頁.
– reference: 4) 田崎哲典：輸血製剤の適正使用のために　輸血検査, 輸血管理はどのように行うべきか 血液製剤の使用指針　新鮮凍結血漿の適正使用. Med Technol 34: 1142-1148 2006.
– reference: 7) 吉岡　章, 藤村吉博, 他：先天性第Ⅴ因子欠乏症（Parahemophilia）の1例 — 自験例と本邦報告例の文献的考察 —. 臨血 16: 953-962 1975.
– reference: 14) 木村　裕, 新垣　晋, 他：先天性第V因子欠乏症患者の抜歯経験. 新潟歯会誌 12: 79-87 1982.
– reference: 15) 坪井徹洋, 新美直哉, 他：先天性第V因子欠乏症患者における抜歯の1例. 日口外誌 44: 1005-10071998.
– reference: 10) 矢島愛治, 鳥居　毅, 他：先天性第Ⅴ因子欠乏症に合併した尿管腫瘍. 臨泌 46: 341-343 1992.
– reference: 6) 宮川創平, 山内　宏, 他：卵巣出血により腹腔内大量出血を起こした先天性第Ⅴ因子欠乏症の1例. 産婦･新生児血液 9: 57-61 1985.
– reference: 5) 須崎　真, 三田正明, 他：先天性第Ⅴ因子欠乏症に併発した腸腰筋血腫の1例. 画像診断 7: 333-335 1987.
– reference: 11) 清水郁夫, 市川直明, 他：複数の凝固因子活性低下を示した高力価の突発性後天性第V因子インヒビター. 臨血 49: 413-416 2008.
– reference: 2) 岸田邦雄, 小柳英樹：先天性第Ⅴ因子欠乏症. 小児科 MOOK 54: 113-118 1988.
– reference: 16) Joseph, C.F. and Margaret, H.: Nature of the defect in congenital factor Ⅴ deficiency: study in a patient with an acquired circulating anticoagulant. Blood 39: 751-758 1972.
– reference: 8) 坂田好史, 三島秀雄, 他：先天性第Ⅴ因子欠乏症を伴う結腸癌の1例. 日消外会誌 36: 1626-1629　2003.
– reference: 9) 三上貞昭, 上田直子, 他：術前凝固スクリーニング異常により発見され, 子宮全摘出術を行った先天性第V因子欠乏症の1症例. 奈良医誌 42: 545-549 1991.
– reference: 12) 真鍋隆宏, 大塚将秀：食道癌術後にみられ第V因子インヒビターによる凝固機能検査異常をきたした1例. ICU とCCU 23: 459-463 1999.
– reference: 3) 篠澤圭子：先天性第Ⅴ因子欠乏症とその遺伝子変異. 日血栓止血会誌 16: 281-296 2005.
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Snippet Blood coagulation factor V is a common factor involved in both intrinsic and extrinsic pathways of coagulation; its congenital deficiency is rare. We report a...
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StartPage 279
SubjectTerms 先天性第V因子欠乏症
後出血
抜歯
Title 抜歯後出血を契機に診断された先天性第Ⅴ因子欠乏症の1例
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