Acquired Hemophilia A Diagnosed Based on Gross Hematuria: A Case Report and Literature Review
Acquired hemophilia A (AHA) is an acquired bleeding disorder caused by neutralizing antibodies (inhibitors) against Coagulation Factor VIII (FVIII:C), causing sudden hemorrhagic symptoms (i.e., subcutaneous bleeding, intramuscular bleeding, and hematuria). Herein, this study is aimed at presenting a...
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Wiley
2024-01-01
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| Series: | Case Reports in Urology |
| Online Access: | http://dx.doi.org/10.1155/2024/2760153 |
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| author | Kenichi Hata Junichiro Kato Yusuke Takahashi Shun Saito Keigo Sakanaka Takahiro Kimura |
| author_facet | Kenichi Hata Junichiro Kato Yusuke Takahashi Shun Saito Keigo Sakanaka Takahiro Kimura |
| author_sort | Kenichi Hata |
| collection | DOAJ |
| description | Acquired hemophilia A (AHA) is an acquired bleeding disorder caused by neutralizing antibodies (inhibitors) against Coagulation Factor VIII (FVIII:C), causing sudden hemorrhagic symptoms (i.e., subcutaneous bleeding, intramuscular bleeding, and hematuria). Herein, this study is aimed at presenting a case of AHA diagnosed based on hematuria and reviewing patients who were diagnosed with AHA due to hematuria. A 67-year-old woman was referred to Atsugi City Hospital with painless gross hematuria that began 4 weeks before presentation. Contrast-enhanced computed tomography (eCT) revealed an approximately 2 cm mass in the right renal pelvis, and the patient’s activated partial thromboplastin time (APTT) was elevated (61.4 s). The day after the endoscopic biopsy, the patient was in shock due to a large retroperitoneal hematoma. Although her condition stabilized after intravenous radioembolization, she underwent emergency surgeries several times because of rebleeding within the next 3 weeks. At that time, APTT was more prolonged at 106.4 s, and the FVIII:C level was 2%. Mixing tests showed an upwardly convex curve after 2-h incubation, indicating the presence of an inhibitor. Factor VIII inhibitor titer was ≥5.1 Bethesda unit (BU)/mL. A combined product of Plasma-Derived Factors VIIa and X (pd-FVIIa/FX), as second-line hemostatic therapy, as well as cyclophosphamide (CYP), were administered after Recombinant Activated Factor VIIa (rFVIIa) had been ineffective. Following this, the Factor VIII inhibitor titer was undetectable, FVIII:C levels were restored, and APTT decreased to within the normal range. Gross hematuria was significantly alleviated. However, the patient died of cytomegalovirus and fungal infections due to prolonged immunosuppressive therapy. Although AHA diagnosed based on hematuria may have a better prognosis than others, there have been occasional cases with severe outcomes. APTT, detected upon initial hematological testing in patients with hematuria, may be a potential indicator of an existing AHA. |
| format | Article |
| id | doaj-art-ec2e1d3eb2b24f0880a5e072ee00058e |
| institution | Kabale University |
| issn | 2090-6978 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Urology |
| spelling | doaj-art-ec2e1d3eb2b24f0880a5e072ee00058e2025-01-02T22:39:43ZengWileyCase Reports in Urology2090-69782024-01-01202410.1155/2024/2760153Acquired Hemophilia A Diagnosed Based on Gross Hematuria: A Case Report and Literature ReviewKenichi Hata0Junichiro Kato1Yusuke Takahashi2Shun Saito3Keigo Sakanaka4Takahiro Kimura5Department of UrologyDepartment of NephrologyDepartment of UrologyDepartment of UrologyDepartment of UrologyDepartment of UrologyAcquired hemophilia A (AHA) is an acquired bleeding disorder caused by neutralizing antibodies (inhibitors) against Coagulation Factor VIII (FVIII:C), causing sudden hemorrhagic symptoms (i.e., subcutaneous bleeding, intramuscular bleeding, and hematuria). Herein, this study is aimed at presenting a case of AHA diagnosed based on hematuria and reviewing patients who were diagnosed with AHA due to hematuria. A 67-year-old woman was referred to Atsugi City Hospital with painless gross hematuria that began 4 weeks before presentation. Contrast-enhanced computed tomography (eCT) revealed an approximately 2 cm mass in the right renal pelvis, and the patient’s activated partial thromboplastin time (APTT) was elevated (61.4 s). The day after the endoscopic biopsy, the patient was in shock due to a large retroperitoneal hematoma. Although her condition stabilized after intravenous radioembolization, she underwent emergency surgeries several times because of rebleeding within the next 3 weeks. At that time, APTT was more prolonged at 106.4 s, and the FVIII:C level was 2%. Mixing tests showed an upwardly convex curve after 2-h incubation, indicating the presence of an inhibitor. Factor VIII inhibitor titer was ≥5.1 Bethesda unit (BU)/mL. A combined product of Plasma-Derived Factors VIIa and X (pd-FVIIa/FX), as second-line hemostatic therapy, as well as cyclophosphamide (CYP), were administered after Recombinant Activated Factor VIIa (rFVIIa) had been ineffective. Following this, the Factor VIII inhibitor titer was undetectable, FVIII:C levels were restored, and APTT decreased to within the normal range. Gross hematuria was significantly alleviated. However, the patient died of cytomegalovirus and fungal infections due to prolonged immunosuppressive therapy. Although AHA diagnosed based on hematuria may have a better prognosis than others, there have been occasional cases with severe outcomes. APTT, detected upon initial hematological testing in patients with hematuria, may be a potential indicator of an existing AHA.http://dx.doi.org/10.1155/2024/2760153 |
| spellingShingle | Kenichi Hata Junichiro Kato Yusuke Takahashi Shun Saito Keigo Sakanaka Takahiro Kimura Acquired Hemophilia A Diagnosed Based on Gross Hematuria: A Case Report and Literature Review Case Reports in Urology |
| title | Acquired Hemophilia A Diagnosed Based on Gross Hematuria: A Case Report and Literature Review |
| title_full | Acquired Hemophilia A Diagnosed Based on Gross Hematuria: A Case Report and Literature Review |
| title_fullStr | Acquired Hemophilia A Diagnosed Based on Gross Hematuria: A Case Report and Literature Review |
| title_full_unstemmed | Acquired Hemophilia A Diagnosed Based on Gross Hematuria: A Case Report and Literature Review |
| title_short | Acquired Hemophilia A Diagnosed Based on Gross Hematuria: A Case Report and Literature Review |
| title_sort | acquired hemophilia a diagnosed based on gross hematuria a case report and literature review |
| url | http://dx.doi.org/10.1155/2024/2760153 |
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