経カテーテル的動脈塞栓術抵抗性の下腹壁血腫を契機に診断された後天性血友病Aの１例

抄録

A woman in her 60s with idiopathic bleeding from the left lower abdominal wall underwent emergent transcatheter arterial embolization (TAE) with a right femoral and left brachial approach. She had anemia and a prolonged activated partial thromboplastin time (APTT). Even after 2 sessions of TAE and subsequent surgical hemostasis, rebleeding developed. In addition, a hematoma due to a pseudoaneurysm of the puncture site in the left arm resulted in compartment syndrome. Later, inactivation of factor VIII activity and the presence of factor VIII inhibitor were demonstrated. The patient was diagnosed with acquired hemophilia A. The hemorrhage was controlled using recombinant activated factor VII (rFVIIa) and immunosuppressive therapy. In this case report, the difficulty in diagnosis of acquired hemophilia A and the importance of early diagnosis and appropriate therapy are discussed.