A 34-year-old woman who presented with intraperitoneal hemorrhage caused by factor VIII inhibitor which developed after her third normal delivery was reported.
She had no previous personal or familial history of any abnormal bleeding. On admission with complaints of ecchymoses, gingival bleeding, and joint swelling, her labolatory examination showed a marked prolonged partial thromboplastin time and a low level of factor VII activity (1.7%). Further study revealed that her serum had a factor VIII inhibitor and its titer was as high as 950 Bethasda units/ml. The charcterization of this inhibitor was as follows; it was eluted at 7S globulin peak in gel filtration with Sephadex G-200, and neutralized with anti-IgG, anti-kappa chain and anti-IgG3 or anti-IgG4 antibodies. it was ‘Type II antibody’ according to the classification by Biggs et al.
She was treated with double filtration plasmapheresis and was given a combination therapy of prednisolone 50 mg/day and cyclophosphamide 100 mg/day with disappearance of bleeding tendency. But with her menstruation she was complainted with anemia and abdominal distention which were attributed to the intraperitoneal hemorrhage from the extra-endometrium of an ovary and Douglas, cul-de-sac on laparotomy. Proplex was administered with improvement. Two months later, factor VIII inhibitor was no longer detected and she was discharged.
