eMedicine Specialties > Hematology > Coagulation, Hemostasis, and Disorders

Factor X: Differential Diagnoses & Workup

Author: Christopher J Steen, MD, Staff Physician, Department of Dermatology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Coauthor(s): Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School; Pere Gascon, MD, PhD, Professor and Director, Division of Medical Oncology, Institute of Hematology and Medical Oncology, IDIBAPS, University of Barcelona Faculty of Medicine, Spain
Contributor Information and Disclosures

Updated: Dec 1, 2008

Differential Diagnoses

Cryoglobulinemia
Hemophilia, Overview
Cushing Syndrome
Immune Thrombocytopenic Purpura
Disseminated Intravascular Coagulation
Multiple Myeloma
Dysfibrinogenemia
Myelodysplastic Syndrome
Factor II
Osler-Weber-Rendu Disease
Factor IX
Scurvy
Factor V
Thrombotic Thrombocytopenic Purpura
Factor VII
Vitamin K Deficiency
Factor VIII
Waldenstrom Hypergammaglobulinemia
Factor XI Deficiency
Wiskott-Aldrich Syndrome
Factor XIII
Hemolytic-Uremic Syndrome

Other Problems to Be Considered

Actinic purpura
Aspirin administration
Corticosteroid administration
Ehlers-Danlos syndrome
Gardner-Diamond syndrome (autoerythrocyte sensitization syndrome)
Henoch-Schönlein purpura
Pseudoxanthoma elasticum
Schwartzman phenomenon
von Willebrand disease  
Waterhouse-Friderichsen syndrome

Workup

Laboratory Studies

  • The prothrombin time (PT) is prolonged in patients with factor X deficiency.
  • The activated partial thromboplastin time (aPTT) is prolonged in patients with factor X deficiency.
  • The Russell viper venom time (RVVT) is prolonged in patients with factor X deficiency; Russell viper venom cleaves factor X to produce active factor Xa.
  • Bleeding time is within the reference range in patients with factor X deficiency.
  • Functional and antigenic factor X assays
    • Functional and antigenic levels are decreased in patients with a type I factor X deficiency state (reduced synthesis of factor X).
    • In a type II factor X deficiency state, the functional level is decreased and the antigenic level varies from within the reference range to a decreased level(production of dysfunctional factor X).
  • Assays for other clotting factors
    • In isolated factor X deficiency, assays of other clotting factors should reveal levels within their respective reference ranges.
    • In factor X deficiency due to vitamin K deficiency or vitamin K antagonist use, assays of other clotting factors reveal decreases in all vitamin K–dependent factors (ie, factor II, factor VII, factor IX, factor X, protein C). Liver disease causes a decrease in the levels of many clotting factors.

More on Factor X

Overview: Factor X
Differential Diagnoses & Workup: Factor X
Treatment & Medication: Factor X
Follow-up: Factor X
References
Further Reading
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References

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  36. Herrmann FH, Navarette M, Salazar-Sanchez L, et al. Homozygous Factor X gene mutations Gly380Arg and Tyr163delAT are associated with perinatal intracranial hemorrhage. J Pediatr. Jan 2005;146(1):128-30. [Medline].

  37. Greipp PR, Kyle RA, Bowie EJ. Factor X deficiency in primary amyloidosis: resolution after splenectomy. N Engl J Med. Nov 8 1979;301(19):1050-1. [Medline].

  38. Rosenstein ED, Itzkowitz SH, Penziner AS, Cohen JI, Mornaghi RA. Resolution of factor X deficiency in primary amyloidosis following splenectomy. Arch Intern Med. Mar 1983;143(3):597-9. [Medline].

  39. McMahon C, Smith J, Goonan C, Byrne M, Smith OP. The role of primary prophylactic factor replacement therapy in children with severe factor X deficiency. Br J Haematol. Dec 2002;119(3):789-91. [Medline].

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Keywords

factor X, factor X deficiency, FX, FX deficiency, Stuart factor, Prower factor, Stuart-Prower factor, autoprothrombin III, thrombokinase, blood coagulation factor X, coagulation factor X, vitamin K deficiency, liver disease, hepatic disease, blood disorder, factor disorder, coagulation disorder, clotting disorder, bleeding disorder, blood factor deficiency, factor deficiency, easy bruising, hematuria, soft-tissue hemorrhages, hemarthroses, recurrent epistaxis, menorrhagia, congenital factor X deficiency, acquired factor X deficiency

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Contributor Information and Disclosures

Author

Christopher J Steen, MD, Staff Physician, Department of Dermatology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Christopher J Steen, MD is a member of the following medical societies: Alpha Omega Alpha and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Pere Gascon, MD, PhD, Professor and Director, Division of Medical Oncology, Institute of Hematology and Medical Oncology, IDIBAPS, University of Barcelona Faculty of Medicine, Spain
Pere Gascon, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, New York Academy of Medicine, New York Academy of Sciences, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Paul Schick, MD, Emeritus Professor, Department of Internal Medicine, Thomas Jefferson University Medical College; Research Professor, Department of Internal Medicine, Drexel University College of Medicine; Adjunct Professor of Medicine, Lankenau Hospital, Wynnewood, PA
Paul Schick, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Hematology, International Society on Thrombosis and Haemostasis, and New York Academy of Sciences
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Ronald A Sacher, MB, BCh, MD, FRCPC, Professor, Internal Medicine and Pathology, Director, Hoxworth Blood Center, University of Cincinnati Academic Health Center
Ronald A Sacher, MB, BCh, MD, FRCPC is a member of the following medical societies: American Society of Hematology
Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; Talecris Honoraria Board membership

CME Editor

Rebecca J Schmidt, DO, FACP, FASN, Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine
Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association
Disclosure: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Amgen Honoraria Speaking and teaching; Ortho Biotech Honoraria Speaking and teaching

Chief Editor

Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
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