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Gastric ulcer bleeding in acquired hemophilia A patient and persistent inhibitor successfully treated with endoscopic methods of hemostasis

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Szczepanik A. B., Pielaciński K., Oses-Szczepanik A. M., Paluszkiewicz P.

Polish Journal of Surgery

2021

vol. 94

issue 3

77-80

Introduction: Acquired hemophilia A (AHA) is an extremely rare, life-threatening bleeding disorder caused by spontaneous development of autoantibodies against clotting factor VIII. Invasive treatments in AHA patients with persistent inhibitor refractory to eradication therapy are highly life-threatening due to the risk of uncontrolled bleeding which responds poorly to surgical methods of hemostasis and bypassing agents. Case report: This paper discusses the case of a 71-year-old patient with idiopathic AHA and persistent high-titer inhibitor (104 BU) refractory to immunosuppressive treatment and immune tolerance induction therapy. The patient was admitted due to acute bleeding from a gastric ulcer, complicated with a laceration in the mucosa of the gastroesophageal junction (Mallory-Weiss syndrome). The patient underwent repeated endoscopic hemostasis procedures – injection therapy and argon plasma coagulation, which stopped the bleeding. The bypassing agent used was a recombinant activated clotting factor VIII (rFVIIa) at a mean dose of 91.26 µg/kg (up to a total of 134 doses administered over 14 days) and a total dose of 855.52 mg. In conclusion, gastric ulcer bleeding in an AHA patient with persistent inhibitor can be effectively treated with endoscopic methods of hemostasis and appropriate doses of rFVIIa.

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1 Polish Journal of Surgery

1 2021

1 Oses-Szczepanik A. M.

1 Paluszkiewicz P.

1 Pielaciński K.

1 Szczepanik A. B.

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Gastric ulcer bleeding in acquired hemophilia A patient and persistent inhibitor successfully treated with endoscopic methods of hemostasis