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[获得性血友病:2024年最新进展]

[Acquired haemophilia: Update in 2024].

作者信息

Lévesque Hervé, Guillet Benoit, d'Oiron Roseline, Benhamou Ygal

机构信息

Service de médecine interne, CHU de Rouen, Normandie université, UNIROUEN, U 1096, 1, rue de Germont, 76000 Rouen, France.

Centre de référence de l'hémophilie et des maladies hémorragiques, constitutionnelles, CHU de Rennes, Rennes, France; EHESP, Institut de recherche en santé, environnement et travail (IRSET) - UMR-S 1085, CHU de Rennes, université de Rennes, Inserm, 35000 Rennes, France.

出版信息

Rev Med Interne. 2024 Nov;45(11):710-725. doi: 10.1016/j.revmed.2024.06.005. Epub 2024 Sep 7.

Abstract

Acquired hemophilia A (AHA) is a rare autoimmune disorder due to autoantibodies against factor VIII, with a high mortality risk. It should be suspected in subjects with abnormal bleedings, especially subcutaneous bleed associated with prolonged activated partial thromboplastin time (aPTT). AHA is often idiopathic but is associated with autoimmune diseases, malignancies, pregnancy and postpartum period or drugs. Treatment is based on haemostatic agents as by-passants agents such as factor VIIa and activated prothrombine concentrate complex or recombinant porcine factor VIII for severe bleeding. Eradication of inhibitor should be established as soon as the diagnosis is confirmed with steroid alone often associated with cytotoxic agents or rituximab, depending on FVIII activity and inhibitor titer. The purpose of this review is to summarize the epidemiology, etiopathogenesis, diagnosis, treatment of AHA and discuss current recommendations.

摘要

获得性血友病A(AHA)是一种罕见的自身免疫性疾病,由针对凝血因子VIII的自身抗体引起,具有较高的死亡风险。对于有异常出血的患者,尤其是伴有活化部分凝血活酶时间(aPTT)延长的皮下出血患者,应怀疑患有该病。AHA通常为特发性,但与自身免疫性疾病、恶性肿瘤、妊娠及产后期或药物有关。治疗基于止血药物,如旁路药物,如凝血因子VIIa和活化凝血酶原复合物浓缩物或重组猪凝血因子VIII用于严重出血。一旦确诊,应尽快根除抑制剂,通常单独使用类固醇,并常联合细胞毒性药物或利妥昔单抗,具体取决于FVIII活性和抑制剂滴度。本综述的目的是总结AHA的流行病学、病因发病机制、诊断、治疗,并讨论当前的建议。

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