Delayed detection of severe hemorrhage in a patient with hemophilia A with inhibitors, who was undergoing home infusion factor replacement therapy for moderate hemorrhage

Abstract

Here, we report the case of a 12-year-old male patient with congenital hemophilia A with inhibitors who experienced two life-threatening bleeding episodes. The boy experienced hemarthrosis of the peripheral joints after a fall. Home infusion of recombinant activated factor VII was undertaken to achieve hemostasis. Four days after the trauma, hematochezia occurred, and we diagnosed him as having bleeding of the ileum. The following year, he experienced hemorrhage of the thenar muscle caused by resistance training, and home infusion was undertaken again. Right flank pain, hematuria, and left lower abdominal pain occurred 10, 14, and 15 days after the injury, respectively. We diagnosed him as having iliopsoas and renal hemorrhage. Our case suggests that home infusion for moderate hemorrhage can prevent or delay the onset of concomitant life-threatening bleeding. It is essential that patients are informed on a continuous basis about the symptoms and initial management of hemorrhage.