Further Outpatient Care
Patients with inherited prothrombin deficiency should receive follow up with a hematologist at a comprehensive center that cares for patients with bleeding disorders. Follow-up should occur on a yearly basis as a minimum.
A hematologist should initially evaluate patients with acquired hypoprothrombinemia. Follow-up care depends on the underlying cause.
Prognosis
Patients with lupus anticoagulant-hypoprothrombinemia syndrome (LAHS) after a viral infection can be expected to spontaneously recover. For example, in a study of children with LAHS, involving two cases studies and a literature review, Sarker et al reported that children with LAHS associated with autoimmune conditions had a prolonged disease course and required an extended period of immunosuppressive treatment. In contrast, children with LAHS related to viral infections either experienced spontaneous disease resolution or required only a short course of immunomodulating therapy. [10]
Few patients with systemic lupus erythematosus–associated LAHS (most cases) have spontaneously recovered. Immunosuppressive therapy successfully controls bleeding and increases prothrombin levels in most patients, though some have had a recurrence of symptoms when drug therapy was tapered.
The prognosis for patients with inherited prothrombin deficiency varies. The degree of deficiency does not always predict the clinical course, as patients with severe deficiency with only mild bleeding tendencies have been reported. Impairment of the procoagulant and anticoagulant activities of prothrombin are speculated to result in a delicate coagulation balance in patients who have mild or no symptoms.
