Isolated factor VII deficiency diagnosed after a life-threatening brain haemorrhage

A 65-year-old man was admitted to another hospital with a life-threatening brain haemorrhage, and laboratory examinations on admission revealed prolon ged prothrombin time with normal activated partial thromboplastin time. To establish the cause of his abnormal coagulation, he was referred to our cli nic. Neither the patient nor his family had any previous history of bleedin g symptoms. His liver function was within normal limits but coagulation tes ts showed increased plasma activities of factors II, VIII, IX, X, with redu ced activities of factors V and VII. The activity of factor VII was less th an 2% but no inhibitor of factor VII was detected in the plasma. We conclud ed that the patient had a rare congenital isolated factor VII deficiency al though. he had not shown earlier bleeding problems, presumably because of c ompensation for the factor VII deficiency by enhanced activities of compone nts of the extrinsic coagulation pathway, factors II, VIII, IX and X.