{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T15:04:59Z","timestamp":1779807899923,"version":"3.53.1"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"40","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10,3]]},"abstract":"<jats:sec>\n                    <jats:title>Rationale:<\/jats:title>\n                    <jats:p>Postoperative hemorrhage is a known complication of anal fistula surgery, but underlying coagulation deficiencies like hemophilia can be a rare and potentially severe cause. In this report, we present a case of recurrent postoperative bleeding after anal fistula surgery caused by hemophilia A.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient concerns:<\/jats:title>\n                    <jats:p>This article reports a 48-year-old Chinese male patient who developed repeated wound bleeding and subcutaneous hematoma in the perianal and scrotal regions after high anal fistula incision and seton placement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Diagnoses:<\/jats:title>\n                    <jats:p>Coagulation studies revealed a significantly prolonged activated partial thromboplastin time of 58.10 seconds. The activated partial thromboplastin time normalized (31.00 seconds) after correction via mixing test. Further coagulation factor activity assays demonstrated a markedly reduced factor VIII level of 2.40 %, leading to a definitive diagnosis of Hemophilia A.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions:<\/jats:title>\n                    <jats:p>Initial hemostatic measures included local compression, suturing, and intravenous hemostatic agents, which proved ineffective. The patient then received fresh frozen plasma transfusions (total 1600\u2009mL); however, no significant improvement was observed. He was subsequently transferred to a specialized center for Factor VIII replacement therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes:<\/jats:title>\n                    <jats:p>The patient\u2019s wound bleeding gradually ceased. At the 17-day follow-up, the wound was nearly healed with no further bleeding episodes observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Lessons:<\/jats:title>\n                    <jats:p>Hemophilia is a risk factor for postoperative bleeding after anal fistula surgery. In patients with moderate or mild hemophilia, symptoms may be subtle, typically only manifesting after trauma or surgery. Therefore, it is crucial to inquire about the patient\u2019s bleeding history and monitor blood test results preoperatively.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/md.0000000000044962","type":"journal-article","created":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T20:06:15Z","timestamp":1759781175000},"page":"e44962","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Postoperative bleeding complicated by hemophilia A following anal fistula surgery: A case report"],"prefix":"10.1097","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6715-4284","authenticated-orcid":false,"given":"Xue","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Proctology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Proctology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ze","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Proctology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Longfang","family":"Quan","sequence":"additional","affiliation":[{"name":"Department of Proctology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaosheng","family":"Bei","sequence":"additional","affiliation":[{"name":"Department of Proctology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20260526","doi-asserted-by":"crossref","first-page":"586891","DOI":"10.3389\/fsurg.2020.586891","article-title":"Advances in the treatment of anal fistula: a mini-review of recent five-year clinical studies.","volume":"7","author":"Ji","year":"2020","journal-title":"Front Surg"},{"key":"R2-20260526","doi-asserted-by":"crossref","first-page":"216","DOI":"10.5482\/HAMO-16-07-0028","article-title":"A new era of treatment for patients with haemophilia A?","volume":"37","author":"Klamroth","year":"2017","journal-title":"Hamostaseologie"},{"key":"R3-20260526","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1186\/s13052-021-01137-x","article-title":"Congenital hemophilia A with low activity of factor XII: a case report and literature review.","volume":"47","author":"Lei","year":"2021","journal-title":"Ital J Pediatr"},{"key":"R4-20260526","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1186\/s40792-021-01272-x","article-title":"Congenital hemophilia A diagnosed with postoperative hemorrhage after thyroidectomy for papillary thyroid carcinoma: a case report.","volume":"7","author":"Saitou","year":"2021","journal-title":"Surg Case Rep"},{"key":"R5-20260526","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1038\/s41572-021-00278-x","article-title":"Haemophilia.","volume":"7","author":"Berntorp","year":"2021","journal-title":"Nat Rev Dis Primers"},{"key":"R6-20260526","first-page":"121","article-title":"Haemophilia B is clinically less severe than haemophilia A: further evidence.","volume":"16","author":"Franchini","year":"2018","journal-title":"Blood Transfus"},{"key":"R7-20260526","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1136\/archdischild-2016-311018","article-title":"Major bleeding disorders: diagnosis, classification, management and recent developments in haemophilia.","volume":"103","author":"Bhatnagar","year":"2018","journal-title":"Arch Dis Child"},{"key":"R8-20260526","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1055\/s-0033-1336832","article-title":"Mixing tests: diagnostic aides in the investigation of prolonged prothrombin times and activated partial thromboplastin times.","volume":"39","author":"Kershaw","year":"2013","journal-title":"Semin Thromb Hemost"},{"key":"R9-20260526","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1055\/s-0032-1326786","article-title":"The diagnosis and management of congenital hemophilia.","volume":"38","author":"Carcao","year":"2012","journal-title":"Semin Thromb Hemost"},{"key":"R10-20260526","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/S0140-6736(15)01123-X","article-title":"The past and future of haemophilia: diagnosis, treatments, and its complications.","volume":"388","author":"Peyvandi","year":"2016","journal-title":"Lancet"},{"key":"R11-20260526","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1146\/annurev-med-043021-033013","article-title":"Adeno-associated virus gene therapy for hemophilia.","volume":"74","author":"Samelson-Jones","year":"2023","journal-title":"Annu Rev Med"},{"key":"R12-20260526","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5507\/bp.2022.046","article-title":"From a bispecific monoclonal antibody to gene therapy: a new era in the treatment of hemophilia A.","volume":"167","author":"Mihaila","year":"2023","journal-title":"Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub"},{"key":"R13-20260526","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/hae.14046","article-title":"WFH guidelines for the management of hemophilia, 3rd edition.","volume":"26","author":"Srivastava","year":"2020","journal-title":"Haemophilia"}],"container-title":["Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/MD.0000000000044962","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T14:29:08Z","timestamp":1779805748000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/MD.0000000000044962"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,3]]},"references-count":13,"journal-issue":{"issue":"40","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.1097\/md.0000000000044962","relation":{},"ISSN":["0025-7974","1536-5964"],"issn-type":[{"value":"0025-7974","type":"print"},{"value":"1536-5964","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,3]]},"assertion":[{"value":"2025-05-29","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-12","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}