case_images: PMC10769896_01
case_images: Patient's profile demonstrating inverse correlation between prothrombin and antibody level. Clinical presentation (A) and protein profile (B, C) in patient's plasma at different sampling numbers shown as sampling no. 1-15 with corresponding dates. (A) Clinical presentation, (B) prothrombin was followed by activity measurements using one-stage assay. Gray area indicates the reference range (0.80-1.30 kIU/L). (C) Nonneutralizing-binding antibody titer was followed by prothrombin as coat in ELISA and shown as standard deviations (SD) above the mean from analyzing plasma samples from healthy donors. The gray area indicates the reference range (<3 SD).
case_images: CCR3-12-e8400-g001.jpg
case_images: PMC10769896_01_CCR3-12-e8400-g001.jpg
case_images: ccr38400-fig-0001
case_images: The patient profile is outlined in Figure 1A. Owren, an extended diagnostic panel revealed factors VII and X activity within normal range, while prothrombin activity was decreased (0.17 kIU/L) (see Table 1 and Figure 1B). Other factor activities (Factors VIII, IX, XI, fibrinogen, and von Willebrand factor) affecting bleeding tendency were either within or above the normal range. The presence of a nonneutralizing-binding antibody was detected, with a clear inverse correlation between the patient's prothrombin and antibody level (Figure 1C). Treatment with four-factor prothromplex concentrate (Ocplex , Octapharma) resulted in an increase in prothrombin activity and a decrease in antibody titer measured by ELISA (see sampling numbers 4 and 5, Figure 1). Ocplex  contains prothrombin and will thus increase levels of measurable prothrombin.