Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 7, 2022; 10(1): 236-241
Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.236
Acquired coagulation dysfunction resulting from vitamin K-dependent coagulation factor deficiency associated with rheumatoid arthritis: A case report
Yan-Jing Huang, Liang Han, Jing Li, Chao Chen
Yan-Jing Huang, Liang Han, Jing Li, Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Chao Chen, Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Chao Chen, Department of Orthopaedics, Hefeng Central Hospital, Enshi 445800, Hubei Province, China
Author contributions: Huang YJ contributed to the conception and design, and data analysis and interpretation; Chen C and Li J contributed to the administrative support, and data collection and assembly; all authors contributed to the provision of study materials, manuscript writing, and final approval of the manuscript.
Supported by the National Natural Science Foundation of China, No. 81803917 and 81904024.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chao Chen, MD, PhD, Doctor, Research Fellow, Surgeon, Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, China. chenchao027@163.com
Received: December 12, 2020
Peer-review started: December 12, 2020
First decision: July 8, 2021
Revised: July 21, 2021
Accepted: November 26, 2021
Article in press: November 26, 2021
Published online: January 7, 2022
Processing time: 382 Days and 17.1 Hours
Abstract
BACKGROUND

Rheumatoid arthritis (RA) is a common chronic inflammatory autoimmune disease with the main clinical feature of progressive joint synovial inflammation, which can lead to joint deformities as well as disability. RA often causes damage to multiple organs and systems within the body, including the blood hemostasis system. Few reports have focused on acquired coagulation dysfunction resulting from vitamin K-dependent coagulation factor deficiency associated with RA.

CASE SUMMARY

A 64-year-old woman with a history of RA presented to our hospital, complaining of painless gross hematuria for 2 wk. Blood coagulation function tests showed increased prothrombin time, international normalized ratio, and activated partial thromboplastin time. Abnormal blood coagulation factor (F) activity was detected (FII, 7.0%; FV, 122.0%; and FX, 6.0%), indicating vitamin K-dependent coagulation factor deficiency. Thromboelastography and an activated partial thromboplastin time mixed correction experiment also suggested decreased coagulation factor activity. Clinically, the patient was initially diagnosed with hematuria, RA, and vitamin K-dependent coagulation factor deficiency. The patient received daily intravenous administration of vitamin K1 20 mg, etamsylate 3 g, and vitamin C 3000 mg for 10 d. Concurrently, oral leflunomide tablets and prednisone were administered for treatment of RA. After the treatment, the patient's symptoms improved markedly and she was discharged on day 12. There were no hemorrhagic events during 18 mo of follow- up.

CONCLUSION

RA can result in vitamin K-dependent coagulation factor deficiency, which leads to acquired coagulation dysfunction. Vitamin K1 supplementation has an obvious effect on coagulation dysfunction under these circumstances.

Keywords: Acquired coagulation dysfunction; Rheumatoid arthritis; Coagulation factor deficiency; Vitamin K-dependent; Case report

Core Tip: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that frequently involves multiple organs and systems, potentially leading to coagulation dysfunction. In this paper, we report the rare case of a patient who was diagnosed with acquired coagulation dysfunction resulting from vitamin K-dependent coagulation factor deficiency associated with RA, and subsequently benefited from vitamin K1 supplementation treatment. This case report may provide some references for diagnosis and treatment of RA patients with coagulation dysfunction symptoms.