一名60岁的轻度甲型血友病患者在接受结肠癌手术后出现了凝血因子VIII抑制剂。

Factor VIII inhibitor developed in a 60-year-old patient with mild hemophilia A after surgery for colon cancer.

作者信息

Suzuki T, Arai M, Miyasaka S, Watanabe J, Sugimura D, Amano K, Yamagishi T, Kagawa K, Fukue H, Fukutake K

机构信息

Department of Clinical Pathology, Tokyo Medical College, Japan.

出版信息

Int J Hematol. 1995 Aug;62(2):127-32. doi: 10.1016/0925-5710(95)00392-6.

DOI:10.1016/0925-5710(95)00392-6

PMID:8590774

Abstract

Most factor VIII inhibitors are developed at an early age and in patients with severe type of hemophilia A. We report a case of newly developed factor VIII inhibitor in a 60-year-old patient with mild hemophilia A who had been treated with several kinds of factor VIII concentrates. The patient was treated with a total of 103,580 units of recombinant factor VIII concentrate by continuous and bolus infusions for the open surgery of sigmoid colon cancer. On the 95th postoperative day, the patient had right low limb muscle bleeding and was infused with 1,000 units of recombinant factor VIII concentrate for three days. Subsequently, the level of factor VIII inhibitor in the patient's plasma was 2 Bethesda units (BU)/ml. Since then numerous subcutaneous hemorrhages developed, but an adequate hemostatic effect was not obtained even with the administration of a high dose of recombinant factor VIII concentrate. The patient was switched to bypass therapy using human plasma-derived factor VIIa concentrate, which showed a favorable hemostatic effect.

摘要

大多数凝血因子 VIII 抑制物在幼年时以及重度甲型血友病患者中产生。我们报告了一例 60 岁轻度甲型血友病患者新出现凝血因子 VIII 抑制物的病例，该患者曾接受过多种凝血因子 VIII 浓缩物治疗。该患者因乙状结肠癌开放手术，通过持续输注和大剂量推注，共接受了 103580 单位的重组凝血因子 VIII 浓缩物治疗。术后第 95 天，患者右下肢肌肉出血，连续三天输注 1000 单位重组凝血因子 VIII 浓缩物。随后，患者血浆中凝血因子 VIII 抑制物水平为 2 贝塞斯达单位（BU）/毫升。此后出现大量皮下出血，即便给予高剂量重组凝血因子 VIII 浓缩物也未获得充分的止血效果。该患者转而接受使用人血浆源性凝血因子 VIIa 浓缩物的旁路治疗，显示出良好的止血效果。