A case of acquired hemophilia turned out after evacuation of subcutaneous hematoma

Abstract

In order to examine renal function, arterial blood sample was taken at the left elbow joint in a 56-year-old man with pustular psoriasis. Then the left hand from the elbow to the shoulder gradually swelled against strong compression on the puncture site, which developed the compartment syndrome. Emergency removal of the subcutaneous hematoma was performed. There was no clotted blood in the subcutaneous space, but serous blood. Bleeding points were not clear even with close examination along the artery. Since serous bleeding still persisted after the surgery, blood transfusion was continued. The patient exhibited severe hypotension and tachycardia state, and fallen in cardiac arrest on the 1st postoperative day. Acquired hemophilia was diagnosed after the death from the examination of preserved plasma. The blood coagulation factor VIII was less than 1% (normal range; 60∼150%) and the auto-antibody to the factor VIII was 15 Bethesda U · ml ^-1 (normal range; undetectable). Acquired hemophilia is a rare disease which produces the auto-antibody to the factor VIII or IX. Activated partial thromboplastin time (APTT) was recognized to be indispensable for the preoperative examination as well as prothrombin time. In case the APTT was extremely prolonged, we need to suspect acquired hemophilia and to prepare against massive bleeding.