後天性血友病A患者に対して凝固第Ⅶ因子補充療法を行うも重篤な抜歯後口腔咽頭喉頭血腫を生じた1例

• Published in: 日本口腔外科学会雑誌 Vol. 65; no. 1; pp. 10 - 15
• Main Authors: 武田, 大介, 小松原, 秀紀, 古森, 孝英
• Format: Journal Article
• Language: Japanese
• Published: 社団法人 日本口腔外科学会 20.01.2019
• Subjects: rFⅦa：遺伝子組換え活性型凝固第Ⅶ因子製剤; バイパス療法; 後天性インヒビター; 後天性血友病A; 抜歯後口腔咽頭喉頭血腫
• ISSN: 0021-5163; 2186-1579
• DOI: 10.5794/jjoms.65.10

Bypass therapy using recombinant activated factor Ⅶ (rFⅦa) or activated prothrombin complex concentrate (APCC) is effective for hemostatic treatment in acquired hemophilia A. We report the case of a 78-year-old man who presented with severe oropharyngolaryngeal hematoma after tooth extraction despite using rFⅦa to manage acquired hemophilia A.　He was referred to our department because of tenderness of the tongue caused by a metal crown of the left mandibular first molar. About 3 months before our first medical examination, the patient was given a diagnosis of acquired hemophilia A, for which he had subsequently received corticosteroids and had undergone bypass therapy using APCC in the Department of Hematology of our hospital. Panoramic radiography revealed chronic apical periodontitis of the same tooth. We consulted a hematologist. For hemostatic management, rFⅦa preparations were transfused before and after the extraction procedure. However, submucosal hematoma and edema developed in the oral floor the next morning and advanced to the root of the tongue and epiglottis on the following 2 days. We urgently performed intratracheal intubation. After that, rFⅦa preparations were transfused every 3 hours, and the patient was extubated 12 days after tooth extraction.