Yokota Sho, Hirabayashi Yasuko, Wakata Mitsuo, Maruyama Yoshiyuki, Mukoyama Arata, Nomura Manami, Hamada Satoshi, Ijichi Noriko, Matsumoto Tomoko, Shima Midori
Department of Hematology, Tachikawa Sougo Hospital.
Rinsho Ketsueki. 2011 Feb;52(2):78-83.
The patient was a 36-year-old man who had been aware of a mild bleeding tendency since childhood, but did not show any history of severe bleeding. After lumbar epidural block was performed for pain caused by lumbar disc herniation, the patient developed paraplegia due to an acute epidural hematoma, and rectovesical disorder. He was admitted to our hospital, and wide fenestration and hematoma evacuation were performed. Because of persistent bleeding, reoperation was performed to achieve hemostasis. Although factor VIII antigen was 138%, its activity was decreased to 18% of normal. A diagnosis of cross-reacting material positive mild hemophilia A was made. Postoperative injection of a factor VIII preparation resulted in complete hemostasis. The activated partial thromboplastin time was within normal range. A thrombin generation test showed reduced endogenous thrombin potential, peak thrombin levels, and prolonged time-to-peak levels. The thrombin generation test, which allows comprehensive assessment of the coagulation profile, was useful for diagnosis and treatment of this case.
患者为一名36岁男性，自幼即意识到有轻度出血倾向，但无严重出血史。因腰椎间盘突出症所致疼痛行腰段硬膜外阻滞术后，患者因急性硬膜外血肿出现截瘫及直肠膀胱功能障碍。他被收入我院，接受了广泛开窗和血肿清除术。由于持续出血，再次手术以实现止血。尽管因子VIII抗原为138%，但其活性降至正常的18%。诊断为交叉反应物质阳性轻度甲型血友病。术后注射因子VIII制剂实现了完全止血。活化部分凝血活酶时间在正常范围内。凝血酶生成试验显示内源性凝血酶潜力、凝血酶峰值水平降低，达峰时间延长。凝血酶生成试验能够全面评估凝血情况，对该病例的诊断和治疗很有用。
