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免疫抑制剂治疗重度获得性血友病A:1例患者的病例报告

Treatment of Severe Acquired Haemophilia A with Immunosuppressive Agent: A Case Report of One Patient.

作者信息

Škunca Željka, Peraica Ana Planinc

出版信息

Coll Antropol. 2016 Jun;40(2):139-43.

Abstract

Acquired haemophilia A (AHA) is a rare hemorrhagic disease caused by an autoantibody against coagulation factor VIII. Nonhaemophiliac patients develop autoantibodies (inhibitors) directed against the factor VIII circulating coagulation protein. Disease is associated with an increased morbidity and mortality. Inhibitors against FVIII induce acute and life-threatening hemorrhagic diathesis because of abnormal blood clotting. FVIII inhibitors demonstrate bleeding disorders and prolonged activated partial thromboplastin time and a normal prothrombin time. AHA should be considered in the differential diagnosis particularly in postpartum women and in the elderly patients with bleeding tendency. Treatment of acute hemorrhage is focused in the control of the acute bleeding episode and the long term suppression of the autoantibody. In congenital hemophilia A with inhibitors, in which using repetitive infusions of high dose FVIII concentrates is effective for inhibitor eradication. This report present one patient treated with immunosuppressive regimens. The most effective fi rst-line treatment for the eradication of factor VIII autoantibodies is the combination of steroides and cyclophosphamide.

摘要

获得性血友病A(AHA)是一种由抗凝血因子VIII自身抗体引起的罕见出血性疾病。非血友病患者会产生针对循环凝血蛋白因子VIII的自身抗体(抑制剂)。该疾病与发病率和死亡率增加相关。由于异常凝血,针对FVIII的抑制剂会引发急性且危及生命的出血素质。FVIII抑制剂表现出出血性疾病、活化部分凝血活酶时间延长以及凝血酶原时间正常。在鉴别诊断中应考虑AHA,尤其是产后妇女和有出血倾向的老年患者。急性出血的治疗重点在于控制急性出血发作以及长期抑制自身抗体。在伴有抑制剂的先天性血友病A中,重复输注高剂量FVIII浓缩物对消除抑制剂有效。本报告介绍了一名接受免疫抑制方案治疗的患者。消除因子VIII自身抗体最有效的一线治疗方法是类固醇和环磷酰胺联合使用。

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