Acquired hemophilia A caused by factor VIII inhibitors: report of a case.
We report a case of acquired hemophilia A (AHA) after esophageal resection. The patient was an 80-year-old woman whose preoperative activated partial-thromboplastin time (APTT) was well within the normal range, at 34.9 s. She underwent thoracic esophagectomy and gastric pull-up for superficial esophageal cancer (operative time, 315 min; intraoperative blood loss, 245 ml). Intrathoracic and subcutaneous bleeding occurred spontaneously on postoperative day (POD) 39. The APTT was prolonged, at 140 s, and factor VIII inhibitor was 36 Bethesda U/ml. Treatment with recombinant activated factor VII, prednisolone, and cyclophosphamide resulted in remission within 2 months. This case supports an association between surgery and the triggering of factor VIII inhibitors. The diagnosis of AHA requires clinical acumen and must be considered in any patient with bleeding and a prolonged APTT.
Department of Surgery, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan. hosoyo@jichi.ac.jp
Yoshinori
Y
Hosoya
Miho
M
Matsumura
Seiji
S
Madoiwa
Toru
T
Zuiki
Shiro
S
Matsumoto
Shin
S
Nunomiya
Alan
A
Lefor
Naohiro
N
Sata
Yoshikazu
Y
Yasuda
D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D003520:Cyclophosphamide / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000379:methods; D005169:Factor VIII / Q000276:immunology*; D015942:Factor VIIa / Q000627:therapeutic use; D005260:Female; D006467:Hemophilia A / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D010314:Partial Thromboplastin Time; D011183:Postoperative Complications; D011239:Prednisolone / Q000627:therapeutic use; D016896:Treatment Outcome
D001323:Autoantibodies; D015415:Biomarkers; D003520:Cyclophosphamide; D005169:Factor VIII; D011239:Prednisolone; D015942:Factor VIIa