[in Japanese]

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[in Japanese]

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A 39-year-old woman was referred to our hospital because of sever bleeding tendency after her first delivery. She presented with postpartum hemorrhage and large hematoma in her abdominal and pelvic cavity. Laboratory findings showed markedly prolonged activated partial thromboplastin time (APTT=71.6sec), a low level of factor VIII (FVIII) activity (3%), and positive FVIII inhibitor (6 BU/ml), and the diagnosis as postpartum acquired hemophilia A was confirmed. Although the bleeding tendency was very severe, it was successfully controlled by infusion of recombinant factor VIIa (Novoseven^®). Pulsed methylprednisolone followed by oral prednisolone alone failed to decrease the titer of inhibitors, while addition of oral cyclosporine A (CyA) at a dose of 200mg/body successfully decreased the titer. And six months later, the FVIII inhibitors completely disappeared. Postpartum acquired hemophilia A is a rare condition, and the etiology and the treatment strategy are not fully discussed. In this patient, the use of rVIIa was very useful in the treatment of severe bleeding complications, while steroid alone showed little effect in decreasing the titer of inhibitors. Addition of CyA was very effective without any serious complications. Appropriate studies on postpartum acquired hemophilia A including the indication of bypass therapy and immunosuppressive therapy with CyA are necessary.

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