Abstract
We report a non-hemophilia patient in whom the appearance of coagulation factor VIII inhibitor during the perioperative period for gastric cancer surgery made it difficult to treat intraperitoneal/-thoracic hemorrhage after surgery. The patient was a 69-year-old man. He was admitted with melena. The prothrombin time (PT) was normal at 12.4 seconds. However, the activated partial thromboplastin time (APTT) was prolonged to 50.9 seconds. Under a diagnosis of hemorrhagic gastric cancer, gastropylorectomy was performed. Hemostasis for intraperitoneal hemorrhage was conducted the day of surgery and 7 days after surgery. Thoracocentesis/drainage for bilateral intrathoracic hemorrhage were carried out 8 days after surgery. A coagulation test showed that the APTT was markedly prolonged, and that coagulation factor VIII activity was reduced (11.6%). A coagulation factor VIII preparation was administered, but there was no increase in coagulation factor VIII activity. The appearance of coagulation factor VIII inhibitor (5 BU/ml) was noted. Prednisolone therapy gradually reduced intraperitoneal/-thoracic hemorrhage, and the patient was discharged. A bleeding tendency related to the appearance of coagulation factor VIII inhibitor is serious in many patients, as demonstrated in the present case. Recognition of this disease and prompt management may be necessary.
