SHM Converge Scientific Abstract ePoster Gallery-Unraveling a Rare Complication: Acquired Hemophilia Emerging Post-Surgery

Pdf Summary

This case report describes a rare but life-threatening complication of surgery: acquired hemophilia A. Acquired hemophilia is an autoimmune bleeding disorder caused by antibodies, usually IgG, that target factor VIII and lead to severe bleeding. It is uncommon, with an annual incidence of 1 to 2 cases per million people, and is often associated with older age, malignancy, autoimmune disease, pregnancy, or certain medications.<br /><br />A 70-year-old man underwent total hip arthroplasty and soon after developed hematemesis with a hemoglobin drop from 14 to 8 g/dL. Upper endoscopy showed no active bleeding, but he later developed ecchymoses and hematomas around IV and PICC sites. Imaging revealed soft tissue bleeding and later a psoas muscle hematoma. Laboratory evaluation showed markedly prolonged PTT, a failed mixing study, factor VIII activity of 1%, and a very high factor VIII inhibitor level, confirming acquired hemophilia A.<br /><br />He was treated with FEIBA, a bypassing agent, along with cyclophosphamide. Despite therapy, he developed atrial fibrillation with rapid ventricular response and continued bleeding, requiring transfusions, including 14 units of packed red blood cells and 1 unit of plasma. Because of ongoing decline, he ultimately chose palliative care and was discharged with hospice.<br /><br />The report emphasizes that acquired hemophilia should be considered in patients with unexplained postoperative bleeding, especially when there is prolonged PTT that does not correct with mixing. Early recognition, hematology consultation, and prompt treatment with immunosuppression and bypassing agents are critical to reduce mortality.

Asset Subtitle

Himanshi Patel

Meta Tag

Author List Himanshi Patel

Category Clinical Vignettes

Concept Acquired Hemophilia A

Concept Factor VIII

Concept Bleeding

Concept Factor VIII Deficiency

Concept Autoimmune disorder

Distinguished Non-Finalist

Presenter Organization Md

Presenting Author Himanshi Patel

Track Adult

Keywords

acquired hemophilia A

postoperative bleeding

factor VIII inhibitor

prolonged PTT

mixing study

total hip arthroplasty

hematemesis

FEIBA

cyclophosphamide

psoas hematoma

Acquired Hemophilia A

Factor VIII

Bleeding

Factor VIII Deficiency

Autoimmune disorder