Korean J Hematol.  2010 Sep;45(3):205-207. 10.5045/kjh.2010.45.3.205.

Acquired factor VIII deficiency after consuming the dried gallbladder of a cobra, Naja naja

• Kim HJ
• Lee WS
• Lee YJ
• Jun HS
• Seo SK
• Joo YD

• KMID: 2252065
• DOI: http://doi.org/10.5045/kjh.2010.45.3.205

Abstract

Acquired factor VIII deficiency is very rare, often fatal. It is associated with pregnancy, autoimmune diseases, malignancy, and drugs, although no underlying cause is found in 50%. A 49-year-old male was referred with right shoulder bruising. The coagulation test showed a prolonged activated partial thromboplastin time. The factor VIII level was less than 1%, and the factor VIII inhibitor antibody titer was 246 Bethesda units/mL. The findings were compatible with acquired factor VIII deficiency. He had consumed the dried gallbladder of a cobra, Naja naja, for two weeks, it contained venom. After the initial treatment with factor VIII, he did not take supplemental coagulation factor VIII. The patient was readmitted with left forearm swelling. He lost consciousness suddenly and brain computed tomography (CT) revealed a subdural hematoma. Despite administering recombinant factor VII, his bleeding was not controlled and he died.

Keyword

Factor VIII inhibitor; Gallbladder of cobra

MeSH Terms

Autoimmune Diseases
Brain
Consciousness
Elapidae
Factor VII
Factor VIII
Forearm
Gallbladder
Hematoma, Subdural
Hemophilia A
Hemorrhage
Humans
Male
Middle Aged
Partial Thromboplastin Time
Pregnancy
Shoulder
Venoms
Factor VII
Factor VIII
Venoms

Figure

• 

  Fig. 1 Subcutaneous hemorrhage of the right shoulder, upper arm, and axilla on admission.

• 

  Fig. 2 The T1-weighted image of magnetic resonance imaging of the left thigh shows an intramuscular hematoma (4.4 cm arrow) of the left vastus medialis.

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  Fig. 3 Axial brain computed tomography shows a left subdural hematoma.

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