Acquired hemophilia A with sigmoid colon cancer: successful treatment with rituximab followed by sigmoidectomy.

Acquired hemophilia A is a rare and potentially fatal condition of coagulopathy caused by autoantibodies against clotting factor VIII (factor VIII inhibitor). We report a case of a 63-year-old woman, who presented with a sudden onset of severe hemorrhagic tendency with exclusively prolonged activated partial thromboplastin time (APTT). She was diagnosed with acquired hemophilia A due to a decrease in factor VIII activity and a high titer of factor VIII inhibitor. Hemorrhage was well controlled by recombinant activated factor VII. Although the level of factor VIII inhibitor did not decline with prednisolone and cyclophosphamide, it became undetectable with rituximab. In parallel with controlling hemorrhage, malignancy, which may cause acquired hemophilia A, was searched for and sigmoid colon cancer was found. After the eradication of factor VIII inhibitor, surgical resection was performed uneventfully. Thereafter, acquired hemophilia A has been in complete remission without any additional therapy. The present case suggests the efficacy of rituximab for refractory acquired hemophilia A and the importance of the identification of underlying diseases that can cause acquired hemophilia A.

[A long-term survivor after relapsed acute myeloblastic leukemia with anthracycline dilated cardiomyopathy].

We watched and analyzed patient cardiac functions especially with a "Phased tracking method" to detect rapid motion of the heart. The patient suffered from congestive heart failure while depending on anthracycline cumulative doses, but now has been living more than 10 years after relapsed acute myeloblastic leukemia. To avoid congestive heart failure with increasing highly tumoricidal anthracycline doses, cardiac function should be monitored closely in connection with treatment schedules and proposed accurate therapeutic index.