Inherited Factor V Deficiency: A Rare Cause of Gingival Bleeding in an Adolescent Girl

Parahaemophilia, sometimes called Owren's disease, is a rare inherited disorder characterised by a lack of clotting factor V in the blood. It can present as uncommon bleeding ranging from mild unprovoked bleeding to a fatal bleed. Reasons for clotting factor deficiency may be due to congenital, acquired, or both. Identifying the deficient clotting factor(s) is crucial, as multiple clotting factors can be deficient in the same patient and the replacement of the deficient factors forms the core of treatment. This case is a 14-year-old female who had had a few instances of minor bleeding since childhood following trivial trauma; menorrhagia and iron deficiency anaemia at menarche. She was on symptomatic treatment until a prolonged bleeding episode. At present, she has a prolonged oozing from the recent tooth extraction site. Laboratory studies showed prolonged Prothrombin Time (PT) and activated Partial Thromboplastin Time (aPTT), and normal Thrombin Time (TT). Mixing studies corrected both PT and aPTT, suggesting a defect in the common pathway of the coagulation cascade and the absence of clotting factor inhibitors. Treatment with antifibrinolytics did not arrest the ongoing bleed. Fresh frozen plasma infusion served as the only modality of treatment. Coagulation factor(s) deficiency can present as chronic iron deficiency anaemia and prolonged bleeding. Identifying the cause is crucial for managing the patient effectively.