[Extracorporeal shock wave lithotripsy in a patient with hemophilia A. A case report]

We treated a 25-year-old hemophilia A patient (FVIII:C activity 2%) with left ureteral stone by means of extracorporeal shock wave lithotripsy under replacement therapy of concentrated Factor VIII material. The patient was attacked by sudden onset of left renal colic with gross hematuria on the 12th postoperative day. Renal ultrasonography and computed tomography demonstrated subcapsular bleeding of the left kidney. In spite of usual antihemophiliac replacement therapy, bleeding was extended from the retroperitoneal space to intraperitoneal and intrapleural space because potent Factor VIII inhibitors (14 Bethesda Unit) was produced. After embolization of the left renal artery, double filtration plasmapheresis and bypassing therapy using prothrombin complex concentrate were performed effectively to save the patient's life.