Abstract
We report a case of retroperitoneal hematoma associated with acquired hemophilia A. The patient was admitted to hospital with lower right abdominal pain. Computed tomography (CT) revealed a retroperitoneal hematoma. Laboratory tests showed a prolonged activated partial thromboplastin time (APTT) and very low factor VIII activity. Angiography revealed bleeding from the right lumbar artery, so transarterial embolization (TAE) was performed. However, his general condition failed to improve and emergency transfer to our hospital. After admission, repeat angiography showed bleeding from a branch of the right external iliac artery, so TAE was performed again. Laboratory tests revealed a high level of factor VIII inhibitor, and a diagnosis of acquired hemophilia A was made. Although TAE was effective for controlling arterial bleeding, venous bleeding continued and his APTT did not improve after infusion of factor VIII concentrate. Accordingly, prednisolone therapy was started to reduce the production of factor VIII inhibitor. Subsequently, the hematoma decreased in size, APTT improved, factor VIII activity increased, and factor VIII inhibitor decreased. The patient's general condition became stable. The combination of TAE and prednisolone can be effective for retroperitoneal bleeding associated with acquired hemophilia A.
