TF and hyperinsulinemic hypoglycemia, familial, 4: Notably, in this case, where intrinsic tenase is either lacking (FVIII deficiency) or relatively bypassed (anti-TFPI), thrombin generation enhancement by HETE-PL is equal, indicating that the lipids can act by stimulating extrinsic tenase (TF/FVIIa) and/or prothrombinase (FVa/FXa).