Jamal Zafar, Rizwan Aziz Qazi, Shajee Ahmed Siddiqui.
Factor V deficiency presenting with hemarthrosis.
J Pak Inst Med Sci Jan ;13(1):659-60.

An 18 years old girl was referred for painful swelling of right knee joint. She had undergone exploratory laparotomy for ruptured ovarian cyst, requiring three pints of blood transfusions to secure haemostasis. She had uneventful recovery and 24 hours later developed swelling of the knee joint. Patient did not volunteer any history of bleeding from any other sites. There was no history of soreness of eye, oral or genital ulcer, photosensitivity and pain or swelling in other joints. Her past medical history was quite significant. She bled from umbilical stump after birth and required stitching. At the age of six years she developed gum bleed at the time of eruption of permanent teeth. On other two occasions she bled from trivial trauma requiring blood transfusions. Joint examination revealed fluid in the joint without any colour change of overlying skin and temperature was mildly elevated. Painful limitations of active and passive movements were also noted. Systemic examination was insignificant except that mentioned in right knee joint examination. Blood complete picture only showed mild anemia with Hemoglobin of 10.7 g/ dl. Renal function test were normal. Her ALT was 67 u/I Prothrombin Time was 48 sec. against control of 12 and APTT was 80 against control of 34. ANA was negative. Bleeding time was 3 minutes. Her Anti-HCV turned out to be positive with negative serology for hepatitis B. Radiological examination of right knee joint was normal. Urea solubility test for Factor XIII was negative. A final diagnosis of Factor V deficiency was made after substitution studies.

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