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Case Report

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Korean J Hematol 2010; 45(3):

Published online September 30, 2010

https://doi.org/10.5045/kjh.2010.45.3.205

© The Korean Society of Hematology

Acquired factor VIII deficiency after consuming the dried gallbladder of a cobra, Naja naja

Hyun Ju Kim1, Won Sik Lee1, Young Jin Lee1, Hyun Soo Jun1, Su-Kil Seo2, and Young-Don Joo3*

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1Department of Hemato-Oncology, Busan Paik Hospital Inje University, Busan, Korea.

2Department of Microbiology, Center for Viral Disease Research College of Medicine, Inje University, Busan, Korea.

3Department of Hemato-Oncology, Haeundae Paik Hospital Inje University, Busan, Korea.

Correspondence to : Correspondence to Young-Don Joo, M.D., Ph.D. Department of Hemato-Oncology, Haeundae Paik Hospital Inje University, 1435, Jwa-dong, Haeundae-gu, Busan 612-030, Korea. Tel: +82-51-797-0653, Fax: +82-51-797-0011, yjoo@inje.ac.kr

Received: July 19, 2010; Revised: July 29, 2010; Accepted: September 2, 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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Acquired factor VIII deficiency is very rare, often fatal. It is associated with pregnancy, autoimmune diseases, malignancy, and drugs, although no underlying cause is found in 50%. A 49-year-old male was referred with right shoulder bruising. The coagulation test showed a prolonged activated partial thromboplastin time. The factor VIII level was less than 1%, and the factor VIII inhibitor antibody titer was 246 Bethesda units/mL. The findings were compatible with acquired factor VIII deficiency. He had consumed the dried gallbladder of a cobra, Naja naja, for two weeks, it contained venom. After the initial treatment with factor VIII, he did not take supplemental coagulation factor VIII. The patient was readmitted with left forearm swelling. He lost consciousness suddenly and brain computed tomography (CT) revealed a subdural hematoma. Despite administering recombinant factor VII, his bleeding was not controlled and he died.

Keywords Factor VIII inhibitor, Gallbladder of cobra

Article

Case Report

Korean J Hematol 2010; 45(3): 205-207

Published online September 30, 2010 https://doi.org/10.5045/kjh.2010.45.3.205

Copyright © The Korean Society of Hematology.

Acquired factor VIII deficiency after consuming the dried gallbladder of a cobra, Naja naja

Hyun Ju Kim1, Won Sik Lee1, Young Jin Lee1, Hyun Soo Jun1, Su-Kil Seo2, and Young-Don Joo3*

1Department of Hemato-Oncology, Busan Paik Hospital Inje University, Busan, Korea.

2Department of Microbiology, Center for Viral Disease Research College of Medicine, Inje University, Busan, Korea.

3Department of Hemato-Oncology, Haeundae Paik Hospital Inje University, Busan, Korea.

Correspondence to: Correspondence to Young-Don Joo, M.D., Ph.D. Department of Hemato-Oncology, Haeundae Paik Hospital Inje University, 1435, Jwa-dong, Haeundae-gu, Busan 612-030, Korea. Tel: +82-51-797-0653, Fax: +82-51-797-0011, yjoo@inje.ac.kr

Received: July 19, 2010; Revised: July 29, 2010; Accepted: September 2, 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Acquired factor VIII deficiency is very rare, often fatal. It is associated with pregnancy, autoimmune diseases, malignancy, and drugs, although no underlying cause is found in 50%. A 49-year-old male was referred with right shoulder bruising. The coagulation test showed a prolonged activated partial thromboplastin time. The factor VIII level was less than 1%, and the factor VIII inhibitor antibody titer was 246 Bethesda units/mL. The findings were compatible with acquired factor VIII deficiency. He had consumed the dried gallbladder of a cobra, Naja naja, for two weeks, it contained venom. After the initial treatment with factor VIII, he did not take supplemental coagulation factor VIII. The patient was readmitted with left forearm swelling. He lost consciousness suddenly and brain computed tomography (CT) revealed a subdural hematoma. Despite administering recombinant factor VII, his bleeding was not controlled and he died.

Keywords: Factor VIII inhibitor, Gallbladder of cobra

Fig 1.

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Figure 1.

Subcutaneous hemorrhage of the right shoulder, upper arm, and axilla on admission.

Blood Research 2010; 45: 205-207https://doi.org/10.5045/kjh.2010.45.3.205

Fig 2.

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Figure 2.

The T1-weighted image of magnetic resonance imaging of the left thigh shows an intramuscular hematoma (4.4 cm arrow) of the left vastus medialis.

Blood Research 2010; 45: 205-207https://doi.org/10.5045/kjh.2010.45.3.205

Fig 3.

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Figure 3.

Axial brain computed tomography shows a left subdural hematoma.

Blood Research 2010; 45: 205-207https://doi.org/10.5045/kjh.2010.45.3.205
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