A Case of Pancreas Head Cancer with Non-Hemophlic Coagulation Factor-VIII Inhibitor

Tomoko Makiuchi, Akira Kobayashi, Shirou Miwa, Terumasa Noike, Satoshi Takagi, Satoshi Iijima, Yusuke Miyagawa and Shin-ichi Miyagawa

Department of Surgery, Shinsyu University School of Medicine

We report surgical treatment of pancreatic head cancer with nonhemophilic coagulation factor-VIII (F-VIII) inhibitor.
An 80-year-old woman admitted for a pancreatic head mass and obstructive jaundice was found. In blood coagulation tests on admission to have prolonged APTT (91.6 s), decreased plasma F-VIII activity (4.8%), and elevated F-VIII inhibitor titer (8.6 BU/ml), yielding a clinical diagnosis of pancreatic head cancer with nonhemophilic coagulation factor-VIII inhibitor. The patient underwent pancreatoduodenectomy receiving a large quantity of F-VIII. No bleeding was observed during surgery. On postoperative day (POD) 44, 24 days after withdrawal of F-VIII, she developed intermuscular bleeding associated with profoundly elevated F-VIII inhibitor titer. She was treated successfully using recombinant factor VIIa, followed by prednisolone. Plasma F-VIII inhibitor titer had normalized by the time she was discharged on POD 86.

Key words
coagulation factor-VIII inhibitor, pancreatoduodenectomy, pancreas cancer

Reprint requests
Tomoko Makiuchi Department of Surgery, Shinsyu University School of Medicine
3-1-1 Asahi, Matsumoto, 390-8621 JAPAN

Accepted
November 26, 2003

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