A Case of Acquired Hemophilia A Complicating Gastric Carcinoma: A Rare Hemorrhagic Condition That Palliative Care Physicians May Encounter

• Published in: Palliative Care Research Vol. 14; no. 4; pp. 253 - 257
• Main Authors: Maekawa, Kenichi, Ito, Tetsuya, Takei, Kiyozumi, Matoba, Motohiro
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society for Palliative Medicine 2019
• Subjects: acquired hemophilia A; factor VIII inhibitor; prolonged APTT; subcutaneous bleeding
• DOI: 10.2512/jspm.14.253

Abstract: We report a case of acquired hemophilia A diagnosed after hospitalization in a palliative care unit. Case: The patient was an 86-year-old man diagnosed with gastric carcinoma one-year prior, who declined treatment but whose progress was being monitored. He was admitted to our hospital due to multiple, systemic, and subcutaneous bleeding and exacerbation of anemia. Blood testing revealed prolonged activated partial thromboplastin time (APTT), but the cause was unknown. Subcutaneous bleeding persisted after hospitalization, accompanied by pain. After admission to a palliative care unit, blood testing revealed only prolonged APTT; hence, a coagulation study was performed, resulting in a diagnosis of acquired hemophilia A. Immunosuppressive therapy was considered but was not performed as the patient’s progress was complicated by aspiration pneumonia for which antibiotics were ineffective, and the patient’s prognosis was determined to be short. The patient died on the 20th day after admission to the palliative care unit. Conclusion: Acquired hemophilia A is a rare hemorrhagic condition, but it is important to suspect it in cases involving prolonged APTT and spontaneous bleeding with no medical history or family history.