A patient has been described with systemic lupus erythematosus and severe bleeding. Her bleeding was associated with a complex plasma coagulation disturbance consisting of profound hypoprothrombinemia plus an anticoagulant active against formed blood and tissue prothrombinase. The problem of the recognition of hypoprothrombinemia in the presence of this type of anticoagulant has been discussed in detail.
An analysis of previously reported cases reveals that our patient’s findings are not unique. It appears that the plasma coagulation disturbances of systemic lupus erythematosus characteristically result from a mixture of anticoagulant activity and true hypoprothrombinemia. In an individual patient one or the other may predominate.