Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android

A rare coagulation factor deficit with poor correlation between serum levels and clinical manifestations.

Hypoproconvertinemia; Congenital Proconvertin Deficiency.

Not precisely known, but estimates range between 1:500,000-1,000,000 live births. Approximately 250 cases have been described in the medical literature.

Autosomal recessive inheritance. Parental consanguinity is a known risk factor. Heterozygous patients are asymptomatic. No sexual predilection. The factor VII (FVII) gene is located on chromosome 13q34, and more than 120 different mutations have been described.

FVII is a vitamin K-dependent clotting factor synthesized in the liver. It is part of the extrinsic clotting cascade and has a half-life of approximately 3 to 4 hours. Specifically, FVII becomes activated (FVIIa) by binding to tissue factor at sites of vascular injury or inflammation. After binding to tissue factor, FVIIa further promotes coagulation by activating FIX and FX. Thus, FVII deficiency prevents initiation of coagulation by the extrinsic pathway and results in a highly variable degree of clinical bleeding, which often does not correlate with plasma levels of FVII, which may be influenced by individual (weight, age, gender), dietary, environmental, and genetic factors. However, generally FVII levels less than 2% of normal values are associated with a significantly increased risk of bleeding.

FVII deficiency is the only hereditary clotting factor deficiency with a prolonged prothrombin time (PT) and a normal activated partial thromboplastin time (aPTT), although confirmation of the diagnosis requires a specific FVII assay.

Depending on the presence of FVII antigen (FVII:Ag) in the plasma, congenital FVII deficiency can be divided in type I or type II. In type I, FVII:Ag deficiency results from either decreased biosynthesis or accelerated clearance, whereas a dysfunctional FVII:Ag characterizes type II. Generally, features may include hemarthros, menorrhagia, hematuria, epistaxis, gingival bleeding, gastrointestinal bleeding, retroperitoneal hematomas, and fatal cerebral hemorrhages or hematomas. Clinically, the disease has been divided in four forms: (1) severe life-threatening form (15% of patients) manifesting with neonatal intracranial bleeding and often lethal course in infancy; (2) severe hemorrhagic form (20%) with recurrent hemarthros and consequently chronic arthropathy; (3) mild, late-onset form (60%) with postoperative cutaneous or mucosal bleeding; and (4) asymptomatic form. Exclude acquired FVII deficiency secondary to liver disease, vitamin K deficiency (warfarin therapy, malabsorption), and, rarely, severe infections. Paradoxically, a few patients develop thrombotic complications such as pulmonary embolus and/or myocardial infarction.

Consult a hematologist for recommendations regarding the use of plasma-derived FVII, a heated-vapor treated product safe from viral transmission. However, because of the delay associated with obtaining FVII concentrate, emergency surgery requires use of prothrombin complex concentrates (FII, FVII, FIX, FX), recombinant FVIIa (rFVIIa), or fresh-frozen plasma (FFP). Because the half-life of FVII is only approximately 3 to 4 hours, repeated replacement therapy quite possibly will be necessary (which, in case of FFP, results in huge amounts of volume required). On very rare occasion, patients develop antibodies against rFVIIa, so patients receiving FVII replacement ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.