インヒビター保有歴のある血友病A患者に対し人工股関節全置換術を施行した1例

抄録

 Although the numbers of surgical procedures are growing for patients with hemophilia, there are only a few reports available regarding patients undergoing total hip arthroplasty (THA) with acquired forms of hemophilia. We report a case of THA performed in a hemophilia A patient with history of an inhibitor.

 A 50-year-old patient hemophilia A, who had a high-responder inhibitor, suffered from pain in his right hip after an operation for a femoral neck fracture. De Palma and Arnold-Hilgartner radiologic classifications were determined as grade Ⅳ and stage Ⅴ, respectively. THA with neutralization therapy using factor Ⅷ was performed according to the hemostatic treatment guidelines for hemophilia patients without inhibitors, established by the Japanese Society of Thrombosis and Hemostasis. On the 8^th postoperative day, factor Ⅷ administered as a continuous infusion after a bolus injection decreased to 12.1%, while the activated partial thromboplastin time prolonged to 95.9 sec, suggesting an anamnestic immune response. Thus, bypass therapy was performed using recombinant activated factor Ⅶ to achieve adequate hemostatic control, and no complications were subsequently noted. At three years and two months postoperatively, no stem subsidence or loosening were found radiologically. The Japanese Orthopaedic Association hip score improved from 43 to 71 points.

 Although no serious complication after THA was noted in our case, we suggest that as compared to hemophilia patients without inhibitors, more care should be taken in managing those with a previous inhibitor history due to an anamnestic immune response.