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Case Reports in Hematology
Volume 2015, Article ID 603402, 3 pages
Case Report

Refractory Epistaxis due to Severe Factor V Deficiency with Inhibitor

1Department of Medicine, Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08901, USA
2University of Central Florida, 4000 Central Florida Boulevard, Orlando, FL 32816, USA
3Division of Hematology and Oncology, University of Florida Health Cancer Center in Orlando, 1400 S Orange Avenue, MP700, Orlando, FL 32806, USA

Received 10 June 2015; Accepted 29 July 2015

Academic Editor: Kate Khair

Copyright © 2015 Elizabeth S. John et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Factor V deficiency secondary to inhibitors is extremely rare and can be caused by a wide collection of exposures such as bovine thrombin and beta lactamase antibiotics. The management of factor V deficiency with inhibitor is a condition treated based on case reports due to the rarity of this condition. We describe a complicated case of an elderly patient with severe factor V deficiency with high inhibitor titer refractory to FEIBA (anti-inhibitor coagulation complex) treated with NovoSeven concurrently with cyclosporine immunosuppression and Rituxan. Given that there are no consensus guidelines on treatment, this case offers important insight into the therapeutic approaches that can be used to treat such patients.