Acquired factor VIII inhibitors in a patient associated with neurosurgery: case report and review of the literature.
OBJECTIVE
Acquired factor VIII inhibitors in patients without hemophilia is rare event characterized by severe bleeding as a result of antibody against factor VIII. We describe a patient who developed subcutaneous and epidural bleeding after the clipping of an unruptured aneurysm.


METHODS
A 57-year-old man suddenly developed coagulopathy after undergoing a neurosurgical operation. Coagulation tests showed a prolongation of activated partial thromboplastin time and a marked reduction in factor VIII activity. Measurement of the factor VIII inhibitor level revealed 2 Bethesda units/ml.


METHODS
The hematoma was removed surgically, and bleeding was controlled with recombinant factor VIII. The patients then received prednisolone (80 mg/d) and cyclosporine. The laboratory tests normalized within 8 weeks. In the 5 years since cessation of corticosteroids, the clinical and laboratory courses of the patient have been uneventful.


CONCLUSIONS
Autoimmune factor VIII inhibitors associated with a neurosurgical procedure are rare. Our case supports an association between surgery and the triggering of factor VIII inhibitors. This complication was probably the result of the surgical procedure or anesthetic agents or other drugs administrated during the perioperative period.
Mikami
Takeshi
T
Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan. tmikami@sapmed.ac.jp
Masauzi
Nobuo
N
Niwa
Jun
J
Houkin
Kiyohiro
K
D000783:Aneurysm / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D001780:Blood Coagulation Tests / Q000379:methods; D003399:Craniotomy / Q000379:methods; D005169:Factor VIII / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D006406:Hematoma / Q000473:pathology / Q000601:surgery*; D006487:Hemostasis / Q000187:drug effects*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications; D012196:Review Literature as Topic
D005169:Factor VIII