Spontaneous Hemorrhages Caused by Plasma-Thromboplastin-Antecedent Deficiency

An increasing number of hereditary hemorrhagic diseases caused by deficiencies in plasma clotting factors has been recognized in recent years. In addition to classic hemophilia or antihemophilic globulin deficiency, two other similar diseases have been described: plasma-thromboplastin-component deficiency, or Christmas disease, 1 and plasma-thromboplastin-antecedent deficiency. 2 In comparison with antihemophelic-globulin and plasma-thromboplastin-componentdeficiencies, hemorrhagic manifestations have been generally less severe in plasma-thromboplastin-antecedent deficiency. Spontaneous hemorrhage has been rare. This paper presents an unusual case of plasmathromboplastin-antecedent deficiency in which spontaneous cerebral hemorrhage produced bizarre neurological symptoms. The prompt disappearance of symptoms after the administration of plasma emphasized the importance of establishing the diagnosis of plasma-thromboplastin-antecedent deficiency. A 38-year-old housewife had an extensive history of abnormal bleeding. At the age of 17, she had had severe postpartum bleeding. At the age of 28, she required five blood transfusions for hemorrhage after mastoid surgery. Three years before the present studies, she bled