PO10 - A Case Report : Diagnostic Approach of Acquired Hemophilia

Background: Acquired hemophilia is a rare case which is caused by the development of autoantibodies directed against one of the antihemophilic factor, most frequently factor VIII. It more common in elderly and may present with catastrophic bleeding without any past medical history of bleeding episodes or disorder. Early diagnosis of acquired hemophilia is often difficult for physician not only because the bleeding manifestation differs from congenital hemophilia, but also because of its rarity and the complexity of the laboratory diagnosis.

Aims: Here, we present a case reports, focus on the diagnostic approach of acquired hemophilia

Methods: We present a patients diagnosed with AHA in this case report.

Results: A 82 years-old male, presented with hematuria and an enlarged prostate and was planned to had a surgery from urologist. he had bruises in his right inferior palpebra, arms and neck since a year ago and were painless. He had a history of taking anti platelet drugs since two years ago due to coronary heart disease. The preoperative laboratory results was shown an elevation of aPTT with normal PT. The result of mixed aPTT examination was still prolonged. So the patient had examination of activity Factor VIII and IX and it was showed a lower FVIII activity ( < 1). The other laboratory resukt also showed a presence of FVIII inhibitor. Based on the data it could be concluded that the patient had acquired hemophilia A.

Conclusion(s): Acquired hemophilia can be suspected in patients presenting with symptoms of bruises without any history of bleeding. Elevation of isolated aPTT with normal PT should raise high suspicion of acquired hemophilia. Confirmation with mixed aPTT test, less activity of FVIII and the presence of FVIII inhibitors can help to confirm the diagnosis of acquired hemophilia A.