A neonatal presentation of factor V deficiency: A case report

A 6-day-old Pakistani boy was admitted with bleeding from the left nipple. His parents were first cousins. A coagulation screen showed a prothrombin time of 41 s (control 14 s), a partial thromboplastin time of 132 s (control 33 s) and a normal thrombin time of 15 s (control 14 s). Factor V activity was <0.01 IU/ml. Oral tranexamic acid was started. At 5 weeks of age the child presented with irritability, lethargy and reduced feeding and a drop of hemoglobin to 5.6 g/dl. A cranial computed tomography scan showed a right intra-cerebral bleed extending from the frontal lobe to the parieto-occipital region with shift of the midline to the left. A regime of 20 ml/kg of fresh frozen plasma four times a week was instituted and has prevented further bleeds up to the present age of 21 months. Neurodevelopment remained normal.This case illustrates that in an unusually bleeding newborn of consanguineous parents rare severe homozygous bleeding disorders need to be considered. Nipple bleeding may be the first presentation of a congenital bleeding disorder. In cases of factor V deficiency where factor concentrates are not available long term use of fresh frozen plasma can prevent potentially life threatening bleeding.Congenital deficiency of factor V (labile factor, proaccelerin) is a rare hereditary coagulation disorder with an incidence of 1:1000,000 and is inherited as an autosomal recessive trait [1]. The active form of coagulation factor V is involved as an essential non-enzymatic cofactor for the activated factor X catalysed conversion of prothrombin to thrombin. Affected patients become symptomatic in early childhood with spontaneous or post-traumatic bleeding complications [2]. We present to our knowledge the first case of nipple bleeding as the initial hemorrhagic manifestation of factor V deficiency in the neonatal period. It preceded an intracerebral hemorrhage.A 6-day-old Pakistani boy was admitted to hospital in June 2005 for bleeding from the left nipple. His paren