Coagulative complete remission following early gastric cancer resection in a patient with steroid-resistant acquired hemophilia A and nephrotic syndrome

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  • MATSUMOTO Akira
    Department of Hematology, Gunma University Graduate School of Medicine
  • OGAWA Yoshiyuki
    Department of Hematology, Gunma University Graduate School of Medicine
  • OSAKI Tsukasa
    Department of Public Health and Hygiene, Yamagata University Faculty of Medicine
  • SOURI Masayoshi
    Department of Public Health and Hygiene, Yamagata University Faculty of Medicine
  • TAKEI Hisashi
    Department of Hematology, Gunma University Graduate School of Medicine
  • ISHIKAWA Tetsuya
    Department of Hematology, Gunma University Graduate School of Medicine
  • KOBAYASHI Nobuhiko
    Department of Hematology, Gunma University Graduate School of Medicine
  • MIYAZAWA Yuri
    Department of Hematology, Gunma University Graduate School of Medicine
  • ISHIZAKI Takuma
    Department of Hematology, Gunma University Graduate School of Medicine
  • INOUE Madoka
    Clinical Laboratory Center, Gunma University Hospital
  • ICHINOSE Akitada
    Yamagata University
  • HANDA Hiroshi
    Department of Hematology, Gunma University Graduate School of Medicine

Bibliographic Information

Other Title
  • 早期胃がん切除により凝固能的完全寛解を達成したネフローゼ症候群合併ステロイド抵抗性後天性血友病A
  • ソウキ イガン セツジョ ニ ヨリ ギョウコノウテキ カンゼンカンカイ オ タッセイ シタ ネフローゼ ショウコウグン ガッペイ ステロイド テイコウセイ コウテンセイ ケツユウビョウ A

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Abstract

<p>During laparoscopic cholecystectomy, an 89-year-old man was discovered to have a prolonged APTT. He was transferred to our hospital for a thorough examination because wound bleeding necessitated a reoperation. Based on coagulation factor VIII activity (FVIII:C) of 3.6% and FVIII inhibitor levels of 48.5 BU/ml, he was diagnosed with acquired hemophilia A (AHA). Due to concerns about his advanced age and postoperative infection, immunosuppressive therapy with prednisolone 0.5 mg/kg/day was initiated. His clinical course was favorable, except hemorrhagic shock caused by intramuscular hemorrhage on the right back, although low FVIII inhibitor levels persisted for more than a month; additionally, lower leg edema and increased urinary protein were also observed. He was diagnosed as with AHA and secondary nephrotic syndrome, possibly because of early gastric cancer. As a result, radical endoscopic submucosal dissection (ESD) was performed while a recombinant coagulation factor VIIa preparation was administered. AHA improved rapidly following ESD, and coagulative remission was achieved. Simultaneously, the nephrotic syndrome improved. Because the control of malignant tumors may improve the status of AHA, the timing of malignant tumor intervention must be considered considering the risk of bleeding and infection associated with immunosuppression.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 64 (3), 203-208, 2023

    The Japanese Society of Hematology

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