TRANSIENT LUPUS ANTICOAGULANT ASSOCIATED WITH PROTHROMBIN DEFICIENCY - UNUSUAL CAUSE OF BLEEDING IN A 5-YEAR-OLD GIRL

Purpose: We present the association of a lupus anticoagulant with hypo prothrombinemia in a 5-year-old girl, who presented with ecchymoses an d a hematoma. This coagulopathy should be included in the differential of bleeding in previously healthy children. Patients and Methods: Coa gulation and immunology laboratory evaluation was performed at the tim e of presentation with bleeding and 2 months later, after complete cli nical recovery. Results: A 5-year-old girl presented with ecchymoses a nd a hematoma after an upper respiratory illness. Laboratory evaluatio n showed prolongation of both the prothrombin time (PT) and activated partial thromboplastin time (aPTT) due to the presence of a strong lup us anticoagulant associated with a decreased level of prothrombin (15 U/dl). Hypocomplementemia was also detected. Bruising resolved spontan eously, and the PT and aPTT gradually normalized. Reevaluation 2 month s later showed that the lupus anticoagulant had disappeared and the pr othrombin deficiency was markedly improved. Conclusions: This case dem onstrates that transient lupus anticoagulants must be included in the differential for bleeding in young children. Also, in children with lu pus anticoagulants, neither the association of hypoprothrombinemia nor the presence of evidence of activation of the immune system appears t o predict whether a patient will have or develop systemic lupus erythe matosus.