[Anesthetic management of a patient with acquired factor V inhibitor]

A 74-year-old man was scheduled for laparoscopic low anterior resection of rectal cancer. Preoperative blood coagulation test showed his prothrombin time (PT) and activated partial thromboplastin time (APTT) remarkably prolonged. However, he experienced only slight epistaxis. Further examination suggested the presence of acquired factor V inhibitor. Plasmapheresis was carried out before surgery to eradicate inhibitors, but improvement of PT and APTT was temporary. We prepared platelet transfusion and recombinant activated factor VII (rFVIIa) for acute intraoperative bleeding, but there were no abnormal episodes during the surgery. On postoperative day 15, the patient suddenly passed blood in his stool, and received platelet transfusion. For the majority of patients with acquired factor V inhibitor, bleeding is usually mild, but fatal bleeding complications have also been reported. Platelet transfusion was effective in the patient described here.