A case of acquired hemophilia A diagnosed because of tongue bleeding while using a toothbrush

Abstract

Acquired hemophilia A is a rare disease diagnosed in the absesnce of a previous history of easy bleeding. The annual incidence rate is reported to be approximately 1.48 patients per million population. We report a case of acquired hemophilia A diagnosed owing to unexpected tongue bleeding during toothbrushing. A 77-year-old woman was referred to our department because of tongue bleeding. The patient had no previous episodes of bleeding tendency. The activated partial thromboplastin time (APTT) was longer than normal on laboratory tests, and the coagulation activity of factor Ⅷ was decreased. In addition, factor Ⅷ inhibitor expression was detected. The patient was given a diagnosis of acquired hemophilia A by our hematologist and was admitted to the hospital. For a diagnosis of hemophilia A, the patient received immunosuppressive and bypass therapies. The APTT and coagulation activity of factor Ⅷ improved gradually after hospitalization for treatment, which consequently stopped the tongue bleeding. So far, no rebleeding has occurred for 7 months. On the basis of our experience, hematologic diseases such as acquired hemophilia A should be considered in the diagnosis of oral bleeding due to unlikely causes.