Abstract
We report a case of acquired hemophilia A associated with retroperitoneal hematoma. The patient was a 75-year-old man. He was transported to our hospital because of transient loss of consciousness and motor paralysis. He exhibited hypovolemic shock state, and CT scans revealed a retroperitoneal hematoma. The prothrombin time (PT) was 27%, PT-international normalized ratio (PT-INR) was 2.09 and the activated partial thromboplastin time (APTT) was 66.7 seconds. Because the prolonged APTT was not corrected when his plasma was mixed with an equal volume of normal plasma, we suspected that the coagulopathy was caused by acquired hemophilia A. Recombinant activated factor VII, corticosteroids, and cyclosporine were effective. Later, we obtained the data demonstrating that the factor VIII activity was less than 1% and the autoantibody to factor VIII was 222.7 Bethesda unit·ml−1. Acquired hemophilia A is a rare disease which causes severe bleeding disorder. In case the APTT was extremely prolonged, we need to suspect acquired hemophilia A. In addition to hemostatic treatment and immunosuppressive therapy, the infection control is important in the management of acquired hemophilia A.
