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Masakatsu Usui, Kenji Miki, Hiroshi Takeishi, Maeng Bong Jin, Shinsaku Imashuku
(Department of Internal Medicine, Uji-Tokushukai Medical Center, Uji, Kioto, Japan)
Med Sci Case Rep 2017; 4:24-27
Reports of acquired hemophilia A (AHA) at the time of tooth extraction in elderly patients are limited. Although current guidelines for the management of AHA recommend activated prothrombin complex concentrate (aPCC; FEIBA) or recombinant factor VIIa (rFVIIa) for hemostasis, followed by prednisolone and/or cyclophosphamide for the eradication of anti-factor VIII inhibitor, management of such patients differs case by case.
CASE REPORT: A 62-year-old Japanese female was found to have AHA with anti-FVIII inhibitor (11.9 BU/mL) when she developed bleeding after tooth extraction. In this case, we successfully managed hemostasis with fresh frozen plasma infusion/plasma exchange followed by a combination of cyclosporine A (CSA)/small dose prednisolone for inhibitor suppression.
CONCLUSIONS: Based on our experience and literature survey, we discussed the benefit/shortcoming of CSA in the management of AHA with high inhibitor titer (>5 BU/mL).