Abstract
A 63-year-old man was referred to our hospital with a diagnosis of cancer of the upper body of the stomach. Preoperative coagulation study revealed the level of PT to be 12.6 sec that was within normal range, but the level of APTT to be prolonged, 56.9 sec. Hemorrhagic gastric cancer was diagnosed and total gastrectomy was performed. On the first postoperative day, hemorrhage from the Roux-Y loop anastomosis into the intestine occurred, for that hemostatic therapy and re-anastomosis were performed. Furthermore, he developed intraabdominal hemorrhage from a portion of the abdominal wall, through where a drain had penetrated. Accordingly hemostatic therapy under laparotomy was performed on the 8th postoperative day. The plasma coagulation factor VIII activity was found to decline to 12.4%. Acquired hemophilia A was likely and administration of prednisolone was started. We immediately referred him to a specialist and he was transferred to a department of hematological medicine in another hospital on the 10th postoperative day. Thereafter the increased activity of antibody against factor VIII, 171.3 BU/ml, was confirmed and acquired hemophilia A was diagnosed. He suddenly developed fatal arrhythmia. Despite cardiopulmonary resuscitation, he died.
In the case of a patient who shows abnormal coagulation or s bleeding tendency of unknown cause, we should keep a possibility of acquired hemophilia in mind.
