A Case of Acquired Hemophilia a after Postoperative Infection of Duodenal Cancer

MAKITA Naoki, KAYAHARA Masato, ZAIMOKU Ryosuke, TAKEI Ryohei, YAGI Yasumichi, OHNISHI Ichiro

doi:10.3919/jjsa.78.1962

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Other Title

十二指腸癌術後感染を契機に発症した後天性血友病Aの1例
症例十二指腸癌術後感染を契機に発症した後天性血友病Aの1例
ショウレイジュウニシチョウガンジュツゴカンセンオケイキニハッショウシタコウテンセイケツユウビョウ A ノ 1レイ

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Description

A 75-year-old man with duodenal cancer underwent subtotal stomach-preserving pancreaticoduodenectomy. On postoperative day (POD) 48, he was noted to have severe anemia. Esophagogastroduodenoscopy revealed esophageal mucosal microbleeding, and the patient was initiated on hemostatic therapy. On POD 53, a fist-sized abdominal mass was palpable in the right lower quadrant on abdominal palpation. Abdominal CT revealed a right retroperitoneal hematoma. On POD 59, a subcutaneous hematoma was detected in the right knee joint. The anemia worsened in severity. CT on POD 65 revealed another new hematoma around the left hip joint extending into the buttocks. The APTT was markedly increased (76.8 sec). Further examination revealed a very low factor-VIII activity level (4 %) and high factor-VIII inhibitor level (8 BU/ml). The patient was diagnosed as having acquired hemophilia A (AHA). Treatment was initiated with recombinant activated factor VII and prednisolone, which resulted in the disappearance from the serum of coagulation factor-VIII inhibitor. The patient was discharged on POD 146. Early diagnosis of AHA is very important to prevent a fatal outcome from severe bleeding. In patients with unexplained abnormal bleeding, it is important to consider AHA in the differential diagnosis.

Journal

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 78 (9), 1962-1967, 2017

Japan Surgical Association

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