ABSTRACT
Hemofilia adquirida A (HAA) é uma doença rara ? incidênciade 1/1.000.000 ao ano -, com maior prevalência em pessoas de65 a 85 anos. A doença caracteriza-se pela presença de autoanticorposcontra fator VIII (FVIII), o que induz a inibição daligação entre este com fator de Von Willebrand e consequenteinativação de sua função anticoagulante. O objetivo deste trabalhofoi apresentar um caso de Hemofilia adquirida A e destacar anecessidade do médico generalista para o reconhecimento destadoença, visto que sua alta taxa de mortalidade - aproximadamentemais de 20% - a torna um importante diagnóstico diferencialde coagulopatias graves. Paciente do sexo masculino, 59anos, com quadro de dor no ombro esquerdo e evolução parahematomas em diversas partes do corpo. Confirmado o diagnósticode hemofilia adquirida A, iniciou-se o tratamento suportivoe de supressão de inibidor de fator VIII, entretanto, houve novossangramentos. Após terapêutica com ciclofosfamida, foi obtidaa supressão das recorrências dos casos hemorrágicos. Devido aposterior desenvolvimento de anemia, o quimioterápico foi suspenso.Um mês após a retirada do fármaco, o paciente segue semreincidência do quadro. O diagnóstico de hemofilia adquirida Aé evidente caso haja o conhecimento prévio dos achados semiológicose sua rotina de investigação laboratorial, mas frequentementeé atrasado devido à falta de familiaridade com a doençapelos médicos generalistas, fator que interfere diretamente nocurso da Hemofilia adquirida A, pois o diagnóstico precoce éum fator determinante para a redução da taxa de mortalidade.(AU)
Acquired hemophilia A (AHA) is a rare disease ? incidence of1/1.000.000 per year - with a higher prevalence in the elderly.The condition is characterized by the presence of autoantibodiesagainst factor VIII, which induces inhibition of its binding tovon Willebrand factor and consequent inactivation of theiranticoagulant function. The objective of this paper was topresent a case of Acquired hemophilia A and emphasize theneed of primary care physicians to recognize this disease, animportant differential diagnosis of severe coagulopathy, withhigh mortality rate. A fifty-nine years old male patient, withleft shoulder pain and development of hematomas in severalareas of the body. The diagnosis of Acquired hemophilia Awas confirmed and supportive treatment and suppression offactor VIII inhibitor was initiated. However, there was furtherbleeding. After therapy with cyclophosphamide, suppressionof recurrent bleeding cases was obtained. Due to furtherdevelopment of anemia, chemotherapy was discontinued.One month after withdrawal of treatment the patient remainswithout recurrence. The diagnosis of Acquired hemophilia Acan be easier done if there is prior knowledge of the clinicalfindings and interpretation of laboratory investigation. Delayeddiagnosis due to lack of familiarity with the disease by generaldoctors directly interferes in the course of Acquired hemophiliaA, because the early diagnosis is a key factor in reducing themortality rate.(AU)
Subject(s)
Humans , Male , Middle Aged , Factor VII/immunology , Hemophilia A/diagnosis , Prednisone/adverse effects , Cyclophosphamide/adverse effects , Early DiagnosisABSTRACT
Introduction Medical intervention in allergies has broadened its perspective, also focusing in the quality of life of patients. Patients are instructed, before using pharmacotherapy agents, to avoid the causal agent. Objective This study aims to analyze the sensitization profile of patients with allergic complaints and identify possible characteristics specific to each age group and gender. Methods A descriptive cross-sectional study included data collected from medical records (from Multi-Test II database, Lincoln Diagnostics Inc. Decatur, Illinois) of 1,912 patients who underwent skin prick test from March to October 2013. Patients were organized and analyzed according to gender, age, and results of the allergens subtypes tested. Results The study was composed of 1,912 patients (60% male and 40% female) of ages between 3 and 87 years. Positive tests were more prevalent in quantity and intensity with the mites Dermatophagoides pteronyssinus and Dermatophagoides farinae, each with 60% of the total analyzed. In second place were pollens, especially Dactylis glomerata and Festuca pratensis. Conclusion The female and male sexes were equally atopic. Fungi and epithelia of dog and cat were not considered potential aeroallergens that could cause symptoms. However, mites are common in Paraná, Brazil. Further studies regarding the pollens are needed, as this study result diverged from the literature...