title: [Acquired hemophilia complicated with hemorrhage induced acute renal failure].
abstract: A 63-year-old woman, without a family history of hemophilia, was admitted to our hospital because of subcutaneous bleeding, intramuscular and intra-articular hematoma, and macroscopic hematuria. On routine blood analysis, a prolonged activated partial thromboplastin time, decreased concentration of factor VIII to less than 1%, and a markedly elevated level of factor VIII inhibitor to 14.1 BU/ml were revealed. Diagnosis of acquired hemophilia was made and she was treated with prednisolone and recombinant activated factor VII (rFVIIa). On day 9 of rFVIIa therapy, she was complicated by acute renal failure (ARF) with increasing macroscopic hematuria. Computed tomography revealed bilateral swelling of the kidneys with bleeding and dilatation of the left renal pelvis. Activated prothrombin complex concentrates (aPCC) was administrated in combination with steroid pulse therapy and hydration. The bleeding tendency, including ARF, was improved with aPCC, and she was treated with prednisolone and cyclophosphamide. She is currently in good health and attending an outpatients' clinic. Acquired hemophilia is associated with various underlying conditions, but our patient did not show any previous history. ARF is a rare complication in acquired hemophilia, requiring a non-invasive treatment combination with early induction of immunosuppressive therapy.
authors.affiliation: Department of Internal Medicine, Division of Hematology and Oncology, Yokohama City Seibu Hospital, St. Marianna University School of Medicine.
authors.forename: Madoka
authors.initials: M
authors.lastname: Takimoto
authors.forename: Shigeki
authors.initials: S
authors.lastname: Nagura
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Sano
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Nagoshi
authors.forename: Ikuo
authors.initials: I
authors.lastname: Miura
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D015942:Factor VIIa / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006417:Hematuria / Q000209:etiology / Q000628:therapy; D006467:Hemophilia A / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006470:Hemorrhage / Q000150:complications* / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007674:Kidney Diseases / Q000150:complications* / Q000628:therapy; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D020551:Pulse Therapy, Drug
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011239:Prednisolone; D015942:Factor VIIa; D008775:Methylprednisolone