title: Management of postoperative hemorrhage associated with factor VIII inhibitor: report of a case.
abstract: This report presents a case that was successfully treated for acquired factor VIII inhibitor after extensive visceral surgery. A 71-year-old male who underwent surgery for bile duct cancer had active bleeding in the abdominal drainage tube on postoperative day (POD) 5, and prolonged activated partial thromboplastin time (aPTT) was detected (83.1 s) on POD 7. An extensive coagulation work-up revealed factor VIII deficiency (1 %), and a diagnosis of an acquired factor VIII deficiency was established when a factor VIII inhibitor of 8 Bethesda units was demonstrated. The patient was treated with activated prothrombin complex concentrate (aPCCs) and bloody discharge was stopped within 3 days. Inhibitor elimination was started using prednisolone on POD 20; rituximab, was administered on POD 74 and 81. Factor VIII inhibitor had disappeared by POD 124, and factor VIII (72 %) and aPTT recovered to 45.9 s. This case report demonstrated the efficacy of aPCCs and rituximab in the treatment of acquired hemophilia associated with visceral surgery.
authors.affiliation: Department of Gastroenterologic Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan. ionishi@kinbyou.hosp.go.jp
authors.forename: Ichiro
authors.initials: I
authors.lastname: Onishi
authors.forename: Masato
authors.initials: M
authors.lastname: Kayahara
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Munemoto
authors.forename: Seisyo
authors.initials: S
authors.lastname: Sakai
authors.forename: Isamu
authors.initials: I
authors.lastname: Makino
authors.forename: Hironori
authors.initials: H
authors.lastname: Hayashi
authors.forename: Hisatoshi
authors.initials: H
authors.lastname: Nakagawara
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Tajima
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takamura
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Kitagawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Tani
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ohta
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D001650:Bile Duct Neoplasms / Q000601:surgery; D015415:Biomarkers / Q000097:blood; D019774:Blood Coagulation Factor Inhibitors / Q000097:blood*; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D005169:Factor VIII / Q000037:antagonists & inhibitors*; D006467:Hemophilia A / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D010314:Partial Thromboplastin Time; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000188:drug therapy* / Q000209:etiology*; D000069283:Rituximab; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D015415:Biomarkers; D019774:Blood Coagulation Factor Inhibitors; D001779:Blood Coagulation Factors; C025667:prothrombin complex concentrates; D000069283:Rituximab; D005169:Factor VIII