Acquired Hemophilia A in an Extremely Old Patient with Multiple Comorbidities: A Case Report

一位具多重共病的極年長者罹患A型後天性血友病之個案報告

李雨蒨(Yu-Chien Lee) ； 張鴻(Hung Chang) ； 陳昭源(Jau-Yuan Chen) ； 林宗豪(Chung Hao Lin) ； 廖國臣(Kuo-Chen Liao) ； 陳運弘(Yun-Hung Chen) ； 陳英仁(Yin Jen Chen)

《台灣老年醫學暨老年學會雜誌》 15卷1期 (2020/02) Pp. 64-71

https://doi.org/10.29461/TGGa.202002_15(1).0006

摘要

Acquired hemophilia is a nonhereditary bleeding disorder caused by the development of autoantibodies against coagulation factors. The most common form is the development of factor VIII inhibitors, also known as acquired hemophilia A (AHA). A rare disease mostly found in pregnant women and elderly people, AHA is especially serious for the elderly due to a mortality rate that can exceed 20% in this population. Diagnosis of AHA should be considered when seeing an elderly patient with subcutaneous bleeding and isolated activated partial thromboplastin time (APTT) prolongation. We present an extremely old man diagnosed with AHA with initial complaints of bloody stool and fever. Hemoptysis, subcutaneous ecchymosis, and intramuscular bleeding developed during his hospitalization course. The AHA diagnosis was later confirmed, and the patient was treated with recombinant factor VIIa.

關鍵字

acquired hemophilia a ； extremely old ； recombinant factor VIIa

並列摘要

後天性血友病是自體免疫對抗體內凝血因子的一種非遺傳性凝血問題。最常見為對抗第八凝血因子的抑制劑（inhibitor），又稱作A型後天性血友病。這是種罕見的疾病，較常出現於產婦及老年人。在老年族群又更顯重要，因年長者的死亡率高達百分之二十。故於臨床上見到皮下出血且部分凝血活酵素原時間（APTT）延長的老年人時，應將此疾病列入鑑別診斷。本文介紹一位極年長的老先生住院診斷和治療的過程。從一開始入院的主訴：血便與發燒，到口腔出血、皮下出血與肌肉內出血，至入院後第四十一天診斷出A型後天性血友病，並立即給予重組第七凝血因子治療的經過。

並列關鍵字

A型後天性血友病 ； 極年長 ； 重組第七凝血因子