Combined life-threatening internal organ bleeding and postpartum hemorrhage associated with acquired hemophilia A

Abstract

Key clinical message: Acquired hemophilia A (AHA) can present as life-threatening bleeding during the postpartum period. Prompt treatment allows patients with AHA to achieve complete remission and have normal subsequent pregnancies.

Abstract: Acquired hemophilia A (AHA) is a rare bleeding disorder caused by the production of autoantibodies against factor VIII (FVIII). AHA can present with severe bleeding, especially in postpartum patient. We report a 38-year-old woman who presented in an emergency department with severe postpartum hemorrhage 2 weeks after cesarean section. Her investigation showed an isolated prolongation of partial thromboplastin time (PTT), low factor VIII assay and a factor VIII inhibitor test, resulting in abnormal Bethesda units which consistent with AHA. This case report highlights the importance of early diagnosis and treatment of AHA. With timely and appropriate management, most patients can achieve a good outcome.

Keywords: acquired hemophilia A; bleeding; factor VIII; postpartum hemorrhage.

FIGURE 1

(A, B) Coronal view and axial view of retroperitoneal mass. The presence of this lesion resulted in the displacement of the small bowel in an anteromedial direction and the kidney in a posterior direction due to its mass effect. The present lesion exhibited an extension that resulted in the compression of the right ureter, with consequent mild right hydronephrosis.

FIGURE 2

Axial view showed right hydronephrosis due to mass effect of large hematoma.