SHM Converge Scientific Abstract ePoster Gallery-Persistent Isolated Prolonged PTT as an Acquired Hemophilia A

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This case report describes a 73-year-old man with multiple comorbidities, including diabetes, hypertension, chronic kidney disease, and renal clear cell carcinoma, who developed acquired hemophilia A. Over the prior three months, he had a deep vein thrombosis, peripheral arterial disease procedures, bruising, shortness of breath, and fatigue, leading to apixaban discontinuation. He then presented with persistent bleeding from a minor, non-traumatic left elbow laceration, along with widespread ecchymoses and signs of anemia.<br /><br />Laboratory testing showed severe anemia (hemoglobin 7.1 g/dL) and an isolated markedly prolonged PTT (107.9 seconds) with near-normal PT, raising suspicion for a coagulation inhibitor. Additional testing confirmed low factor VIII activity and a high Bethesda assay, establishing the diagnosis of acquired hemophilia A. Imaging also revealed other concerning findings, including a spiculated left upper lobe lung mass and abdominal hematoma.<br /><br />The patient was treated with immunosuppressive and hemostatic therapy, including cyclophosphamide, dexamethasone, rituximab, emicizumab, and recombinant factor VIIa. His bleeding resolved, and he was discharged after about 12 days.<br /><br />The report emphasizes that acquired hemophilia A is rare but potentially life-threatening, usually caused by autoantibodies against factor VIII. It often presents with spontaneous skin, soft tissue, or mucosal bleeding, and diagnosis is frequently delayed because isolated prolonged aPTT is overlooked. The authors stress that persistent isolated PTT prolongation, especially in high-risk patients, should prompt immediate evaluation for factor inhibitors to avoid delayed diagnosis and serious complications.

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Ana L. Chavez Velasquez

Meta Tag

Author List Aashish Anunaya, Ana L. Chavez Velasquez, Azfar Hameed, Elizabeth Chandy, Kamran Chaudhry, Martha Danhof, Richard Ward, Satya H. Manda, Savannah Eren, Scott M. Keeney, Sonakshi Mirchandani

Category Clinical Vignettes

Concept Acquired Hemophilia A

Concept Partial Thromboplastin Time

Concept Inhibitor

Concept Soft Tissue Bleeding

Concept Factor VIII Activity

Distinguished Non-Finalist

Presenter Organization Texas Health Resources HEB/Denton

Presenting Author Ana L. Chavez Velasquez

Track Adult

Keywords

acquired hemophilia A

factor VIII inhibitor

prolonged PTT

spontaneous bleeding

ecchymoses

Bethesda assay

immunosuppressive therapy

emicizumab

recombinant factor VIIa

coagulation disorder

Acquired Hemophilia A

Partial Thromboplastin Time

Inhibitor

Soft Tissue Bleeding

Factor VIII Activity