A Patient who Developed Acquired Hemophilia a after Transfusion for Anemia Caused by Gastric Cancer: Difficulty in Timing the Operation

Abstract

A 65-year-old man was referred to our hospital with severe anemia caused by a bleeding advanced gastric cancer. Although his activated partial prothrombin time (APTT) on admission was within normal limits, it abruptly became prolonged after transfusion. Surgery was performed without awaiting the results of coagulation tests submitted for differential diagnosis, which included acquired hemophilia A (AHA), because gastric cancer was the definitive cause of the anemia. On the second postoperative day, intra-abdominal bleeding occurred, and by that time the coagulation tests showed a high titer of factor VIII inhibitor, confirming the diagnosis of AHA. The patient was treated with recombinant activated factor VII. On the 7th postoperative day, anastomotic bleeding occurred but was successfully treated by endoscopic hemostasis. Thereafter, the APTT returned to normal limits. On the 58th postoperative day, the patient was discharged from the hospital.
AHA rarely develops after transfusion. Once it develops in the perioperative period, it is often fatal; however, the decision as to which takes priority, surgery for advanced cancer or treatment for AHA, is often difficult. When a prolonged APTT is found on preoperative examination, surgeons should suspect AHA and give full consideration to its treatment, as well as the appropriate timing of surgery.