title: [Clinical evaluation of three elderly cases with acquired hemophilia A].
abstract: In this paper we report our clinical investigation of three cases with acquired hemophilia A treated in our department. These patients were all elderly males (79, 77, and 68 years old), and presented with subcutaneous bleeding, a prolonged activated partial thromboplastin time (APTT), and anemia. On the basis of these findings as well as decreased factor VIII activities (0.9~3.1%) and the presence of factor VIII inhibitors (57.1~173 BU/ml), we made a diagnosis of acquired hemophilia A. In cases 1 and 2, a recombinant activated factor VII was used to achieve hemostasis. The factor VIII inhibitor disappeared with prednisolone (PSL) alone in case 1 and a combination of PSL and cyclophosphamide in case 2. In case 3, treatment involving five courses of weekly rituximab (RTX) reduced the activity of factor III inhibitor to 3.5 BU/ml (and subsequently to zero). During this time, the patient achieved hemostasis without using a specific hemostatic agent, and was again referred to the previous hospital for the treatment of hepatocellular carcinoma. Although PSL is often chosen as a first-line therapy to suppress the production of factor VIII inhibitor, which may cause acquired hemophilia A, RTX may be another therapeutic option in some patients.
authors.affiliation: Department of Internal Medicine and Hematology, Aiiku Hospital.
authors.forename: Makoto
authors.initials: M
authors.lastname: Saito
authors.forename: Kentaro
authors.initials: K
authors.lastname: Wakasa
authors.forename: Akio
authors.initials: A
authors.lastname: Mori
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Irie
authors.forename: Masanori
authors.initials: M
authors.lastname: Tanaka
authors.forename: Masanobu
authors.initials: M
authors.lastname: Morioka
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ieko
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D005169:Factor VIII / Q000037:antagonists & inhibitors; D017809:Fatal Outcome; D006467:Hemophilia A / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D003520:Cyclophosphamide; D005169:Factor VIII; D011239:Prednisolone