術後出血をくり返したHemophilia Bの1症例

Unusual Postoperative Hemorrhage in a Patient of Ruptured Aneurysm with Hemophilia B

I．はじめに

　脳動脈瘤破裂で発症し，術後に脳内血腫，さらには硬膜外血腫と奇異な出血を繰り返した症例を経験した．術前の出血凝固系検査には異常なかったが，その後の精査の結果凝固第9因子の低下がみられ軽症型血友病B罹患者であると思われた．軽症型血友病は自発出血を生じないことに加えて，一般の出血凝固系検査に異常を示さないことがあるので臨床上常に留意すべきであり，術後出血の原因としても考慮すべき病態であると痛感されたので報告する．

A case of ruptured cerebral aneurysm with hemophi-lia B is reported, and discussion is made concerning the management of mild type hemophilia in surgical opera-tions

A 41-year-old male came to our hospital with com-plains of severe headache, vomiting, and transient con-sciousness disturbance. His dentist said the patient had a mild bleeding tendency when he was 30 years old, however no postoperative hemorrhage was repeated in appendectomy in his childhood. He also had had no episodes of spontaneous bleeding.