Acquired hemophilia A (AHA) is a rare coagulation disorder caused by autoantibodies against coagulation factor VIII (FVIII). We report herein a case of AHA whose severe bleeding were successfully managed during the perioperative period of the surgery for chronic subdural hematoma by using recombinant activated factor VII (rFVIIa). A 54-y ear-old man was hospitalized due to cardioembolic MCA (middle cerebral artery)occlusion. He experienced severe and persistent urethral bleeding after urinary

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... jury by urethral catheterization during the hospitalization, and the laboratory test showed significant prolonged APTT. He was referred to our hospital to examine the cause of APTT prolongation. FVIII activity was markedly decreased to 8.0% and FVIII inhibitor was high as 2.0 BU/ ml, therefore he was diagnosed as having AHA. The immuno-suppression treatment with prednisolone 0.5 mg/ kg was immediately started. He developed left subdural hematoma with significant midline shift in CT scan on the 9th hospital day . The urgent surgery was performed under the management to prevent severe bleeding by rFVIIa and no severe bleeding occurred. He achieved complete remission on the 19th hospital day after then. Although AHA relapsed during tapering of prednisolone, he achieved remission again by increasing prednisolone.