SHM Converge Scientific Abstract ePoster Gallery-A Case Study of Acquired Hemophilia a in a 93 Yo Female Presenting With Thigh Hematoma

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This case report describes a 93-year-old woman with acquired hemophilia A (AHA), a rare autoimmune bleeding disorder caused by inhibitors against factor VIII. AHA becomes more common with age and is often missed because patients may present with vague symptoms rather than obvious bleeding.<br /><br />The patient had 4 days of right leg pain and a spontaneous thigh hematoma. Initial vascular ultrasound was negative, but CT imaging showed edema in the vastus lateralis and a joint effusion consistent with bleeding. Laboratory testing revealed severe isolated prolongation of aPTT (200 seconds) with a near-normal INR (1.3), anemia (hemoglobin 8.7 g/dL), and very low factor VIII activity (2%). A mixing study failed to correct the aPTT, supporting the presence of an inhibitor and confirming the diagnosis of acquired hemophilia A.<br /><br />She was treated with hemostatic and supportive therapy, including prothrombin complex concentrate (PCC), desmopressin, and prednisone. Over the hospital course, her hemoglobin improved and her aPTT gradually normalized, while factor VIII levels rose from 2% to 21% by discharge. She was sent home on a prednisone taper.<br /><br />The report emphasizes that AHA should be considered in elderly patients with unexplained hematomas and isolated prolonged aPTT. Early recognition is critical because delayed diagnosis can lead to life-threatening bleeding and mortality rates of 8–22% if untreated. Monitoring factor VIII activity and aPTT is important to assess response to treatment.

Asset Subtitle

Serene Mirza

Meta Tag

Author List Brett M. Sherman, David Fruchter, Serene Mirza, Tharaka Wijesinghe, Vongai Tizora

Category Clinical Vignettes

Concept Acquired Hemophilia A

Concept Partial Thromboplastin Time

Concept Factor VIII

Concept Factor VIII Activity

Concept Mixing Study

Distinguished Non-Finalist

Presenter Organization Mount Sinai West/Morningside

Presenting Author Serene Mirza

Track Adult

Keywords

acquired hemophilia A

factor VIII inhibitor

prolonged aPTT

spontaneous hematoma

elderly patient

bleeding disorder

mixing study

desmopressin

prothrombin complex concentrate

prednisone

Acquired Hemophilia A

Partial Thromboplastin Time

Factor VIII

Factor VIII Activity

Mixing Study