Coagulation Conundrum: A Case of an Elevated INR Secondary to Combined Factor V and VII Deficiency
Bibliographic record
Abstract
Congenital factor V (FV) and factor VII (FVII) deficiency is a rare coagulopathy, caused by two distinct independently segregating genetic defects. A 54-year-old female presented to hospital with non-ST elevation myocardial infarction. Workup revealed an elevated international normalized ratio (INR) of 2.0 (normal range 0.8–1.2). Thrombin time (TT), partial thromboplastin time (PTT), and Clauss fibrinogen were normal. Her only prior bleeding event was a lower gastrointestinal (GI) bleed occurring during antiplatelet therapy. She was not on chronic anticoagulant therapy. Her INR did not correct to normal despite 30 mg of oral/intravenous vitamin K. Hepatic synthetic function was normal arguing against an acquired coagulopathy of liver disease. Coagulation factor levels revealed reduced levels of FV and FVII. A combined congenital FV and FVII deficiency was felt to be the most likely diagnosis. During her hospital stay, she underwent coronary artery bypass grafting with perioperative recombinant FVIIa and is expected to have confirmatory genetic testing. Our case demonstrates the value of a thorough bleeding history and the importance of following up patients with such a history.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.005 | 0.004 |
| Science and technology studies | 0.005 | 0.004 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.003 | 0.004 |
| Research integrity | 0.011 | 0.008 |
| Insufficient payload (model declined to judge) | 0.004 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".