Improvement of clinical test system so as to not overlook thrombotic disorders: A case of acquired hemophilia A found by intralaboratory cooperation

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  • 凝固異常症を見逃さないための検査システムの改善―検査室内の連携により発見できた後天性血友病Aの1例を経験して―

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Abstract

<p>Acquired hemophilia A is usually indicated by the prolongation of APTT. We had an opportunity to identify patients with acquired hemophilia A by communicating with different laboratory divisions. A male aged 80, who was suspected of having miliary tuberculosis, was introduced to our hospital for detailed examinations. He was firstly subjected to echocardiography because of massive subcutaneous hemorrhage. Then, the physiology lab technician consulted with the blood examination division. The platelet count of the patient was normal, but our laboratory recommended further examination of his clotting time on the basis of his APTT finding of 100 s, which was determined using an inhibitor type of a cross-mixing test. The activity of factor VIII was lower than 1%, and the factor VIII inhibitor was positive. Finally, he was diagnosed as having acquired hemophilia A. After reviewing the lab data retrospectively, the APTT test was performed 1 month earlier, and it showed a prolonged clotting time, but nobody noticed it as a problem. To prevent overlooking abnormal data, we have started to show such data with colored characters on a viewer, which is confirmed by multiple staff members.</p>

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