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Cyclosporine Treatment in a Case of Acquired Hemophilia A Diagnosed After Tooth Extraction

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

DOI: 10.12659/MSCR.904123

BACKGROUND: 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).

Keywords: Cyclosporine, Hemophilia A, Prednisolone, Shock, Hemorrhagic, Tooth Extraction

This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
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