Transient lupus anticoagulant with a prolonged activated partial thromboplastin time secondary to cytomegalovirus-related infectious mononucleosis.
Transient lupus anticoagulant with a prolonged activated partial thromboplastin time secondary to cytomegalovirus-related infectious mononucleosis.
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短暂性狼疮抗凝剂，可延长继发于巨细胞病毒相关传染性单核细胞增多症的活化部分凝血活酶时间。
DOI：
10.1007/s00277-012-1532-0
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Motoji T.
中科院分区：
文献类型：
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作者：
Shimura H;Imai Y;Ieko M;Shiseki M;Mori N;Teramura M;Motoji T.
尊敬的编辑：一位39岁的男性因发热2周、肝脾肿大而入住我院。实验室数据显示血液中存在非典型淋巴细胞和血清转氨酶升高（表1）。病毒感染筛查显示既往有EB病毒感染。急性原发性巨细胞病毒（CMV）感染诊断酶联免疫吸附试验（西门子，德国）和定量CMV DNA聚合酶链反应试验。凝血常规检查显示活化部分凝血活酶时间（APTT）延长，纤维蛋白原降解产物（FDP）和D-二聚体水平升高。随后的凝血因子活性检查显示因子VIII（97%）和IX（88%）的活性正常，因子XI（73%）和XII（41%）的活性轻微降低。内源性凝血因子抑制剂检测结果为阴性。混合研究未能纠正APTT，表明存在循环抗凝剂。患者IgG抗心磷脂抗体（aCL）阳性，但抗β2GPI、抗磷脂酰丝氨酸-凝血酶原和IgM aCL抗体阴性。对狼疮抗凝剂（LA）敏感的APTT试剂（Roche Diagnostics，日本东京）反应的PTT延长（109.1秒;正常范围，< 55.5秒）。稀释的拉塞尔蝰蛇毒液时间筛选/确认比（LA测试孔; Medical and Biological Laboratories，名古屋，日本）为1.44（正常范围，< 1.3）。因此，根据既定的LA指南确认了LA [1]。用我们最近报道的基于含凝血因子的辅助试剂的方法也检测到了LA [2]，患者在5天后无发热。未观察到出血或血栓形成事件。APTT延长、FDP和D-二聚体水平逐渐改善，4周后恢复正常。此时完成的LA试验结果为阴性，混合研究显示正常模式。
Dear Editor, A 39-year-old man was admitted to our hospital with a 2-week history of fever and an enlarged liver and spleen. Laboratory data revealed the presence of atypical lymphocytes in the blood and elevated serum transaminases (Table 1). Screening for viral infections showed previous Epstein–Barr virus infection. Acute primary cytomegalovirus (CMV) infection was diagnosed by enzyme-linked immunosorbent assay (SIEMENS, Germany) and quantitative CMV DNA polymerase chain reaction tests. Routine tests of blood coagulation revealed prolongation of activated partial thromboplastin time (APTT) and elevated fibrinogen degradation product (FDP) and D-dimer levels. Subsequent examination of coagulation factor activities revealed normal activity of factors VIII (97%) and IX (88%) and slight reduced activity of factors XI (73%) and XII (41%). Tests for intrinsic coagulation factor inhibitors were negative. Mixing studies failed to correct APTT, indicating the presence of a circulating anticoagulant. The patient was positive for IgG anticardiolipin antibody (aCL) but was negative for anti-β2GPI, anti-phosphatidylserine–prothrombin, and IgM aCL antibodies. PTT in response to a lupus anticoagulant (LA)-sensitive APTT reagent (Roche Diagnostics, Tokyo, Japan) was prolonged (109.1 s; normal range,< 55.5 s). Dilute Russell's viper venom time screen/confirm ratio (LA test Gradipore; Medical and Biological Laboratories, Nagoya, Japan) was 1.44 (normal range,< 1.3). Therefore, LA was confirmed according to established guidelines for LA [1]. LA was also detected using our recently reported method based on an auxiliary reagent containing coagulation factors [2].The patient became afebrile 5 days later. No hemorrhagic or thrombotic episodes were observed. Prolongation of APTT and FDP and D-dimer levels gradually improved and returned to normal after 4 weeks. The results of a LA test completed at this time were negative, and mixing studies showed normal patterns.