Acquired hemophilia A developing cerebral infarction 36 days after the frequent administration of bypass hemostatic agents

  • Makoto Saito | ikyoku@aiiku-hp.or.jp Department of Internal Medicine and Hematology, Aiiku Hospital, Japan.
  • Hajime Senjo Department of Internal Medicine and Hematology, Aiiku Hospital, Japan.
  • Minoru Kanaya Department of Internal Medicine and Hematology, Aiiku Hospital, Japan.
  • Koh Izumiyama Department of Internal Medicine and Hematology, Aiiku Hospital, Japan.
  • Akio Mori Department of Internal Medicine and Hematology, Aiiku Hospital, Japan.
  • Masanori Tanaka Department of Internal Medicine and Hematology, Aiiku Hospital, Japan.
  • Masanobu Morioka Department of Internal Medicine and Hematology, Aiiku Hospital, Japan.
  • Masahiro Ieko Department of Internal Medicine, Health Sciences University of Hokkaido, Japan.

Abstract

A 74-years-old male who was a smoker and received treatment for hypertension, dyslipidemia, peripheral arterial disease and idiopathic interstitial pneumonia complained of subcutaneous hemorrhage of the right lower thigh. Marked anemia (hemoglobin 5.5 g/dL) and prolonged activated partial thromboplastin time (≥130 seconds) were noted. The factor VIII activity level was reduced to 1.2%, and the factor VIII inhibitor titer was 285.3 BU/mL, a diagnosis of acquired hemophilia A (AHA) was made. Then, hematomas of 5 intra-muscles were recurred. Hemostasis became difficult despite frequent and high-dose administration of recombinant human coagulation factor VIIa (total: 18 days, 305 mg). Hemostasis was achieved by switching to activated prothrombin complex concentrate (for 3 days, 18,000 units), however, cerebral infarction occurred after 36 days. After the frequent administration of bypass hemostatic agents on elderly AHA patients with several risk factors for ischemic stroke, the risk of subsequent thrombotic events may persist for 1 month.

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Published
2018-09-05
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Section
Case Reports
Keywords:
Acquired hemophilia A, bypass hemostatic agents, cerebral infarction.
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How to Cite
Saito, M., Senjo, H., Kanaya, M., Izumiyama, K., Mori, A., Tanaka, M., Morioka, M., & Ieko, M. (2018). Acquired hemophilia A developing cerebral infarction 36 days after the frequent administration of bypass hemostatic agents. Hematology Reports, 10(3). https://doi.org/10.4081/hr.2018.7453