ABSTRACT
Acquired Factor X deficiency is a rare hematological disease, characterized by excessive bleeding, with fewer than 50 cases reported in the literature and practically all being associated with amyloidosis. We describe a case of a 38-year-old man with no known family history of hematologic disorders who had symptoms of a mild COVID-19 infection. Upon resolution, he developed excessive bleeding features, including epistaxis and hematuria. It was later found that while the rest of the coagulation factors were within normal limits, Factor X was 7% of the normal value, which reversed about two months after recovery. Our case highlights the significance of the less-expected post-COVID bleeding complications, in contrast to the classically seen thrombotic ones.
ABSTRACT
The skin often provides initial clues of hypercoagulability with features such as livedo reticularis, livedo racemosa, retiform purpura, necrosis, and ulcerations. Because these cutaneous manifestations are nonspecific, laboratory testing is often needed to evaluate for underlying causes of hypercoagulability. Importantly, these disorders are reported to be the most common mimicker, resulting in an erroneous diagnosis of pyoderma gangrenosum. Understanding inherent properties of, and indications for, available tests is necessary for appropriate ordering and interpretation of results. Additionally, ordering of these tests in an indiscriminate manner may lead to inaccurate results, complicating the interpretation and approach to management. This second article in this continuing medical education series summarizes information on methodology, test characteristics, and limitations of several in vitro laboratory tests used for the work up of hypercoagulability and vasculopathic disease as it pertains to dermatologic disease.