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

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

Keywords

Acquired hemophilia A; bypass hemostatic agents; cerebral infarction.

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Submitted: 2017-10-16 14:05:55
Published: 2018-06-27 11:10:50
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Copyright (c) 2018 Makoto Saito, Hajime Senjo, Minoru Kanaya, Koh Izumiyama, Akio Mori, Masanori Tanaka, Masanobu Morioka, Masahiro Ieko

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