Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2025 Oct 31:18:11795476251391058.
doi: 10.1177/11795476251391058. eCollection 2025.

Atypical Postoperative Bleeding as a First Manifestation of Acquired Hemophilia A: A Case Report

Maciej Michalak  1 , Agnieszka Piróg  1 , Paweł Andruszkiewicz  1 , Mateusz Zawadka  1
Affiliations
Case Reports

Atypical Postoperative Bleeding as a First Manifestation of Acquired Hemophilia A: A Case Report

Maciej Michalak et al. Clin Med Insights Case Rep. .

Abstract

Acquired hemophilia A (AHA) is a rare autoimmune coagulopathy disorder characterized by the development of inhibitory autoantibodies against coagulation factor VIII. It often presents with spontaneous or post-procedural bleeding in individuals without prior bleeding history and requires prompt recognition and management. We report the case of a 70-year-old male who developed life-threatening hemorrhagic complications following pancreaticoduodenectomy. Re-laparotomy revealed dehiscence of the pancreaticojejunostomy, which was resected, and a temporary Wirsungostomy was created. The patient was admitted to the Intensive Care Unit (ICU) with progressive anemia, subcutaneous hematomas, and recurrent gastrointestinal bleeding. Laboratory tests revealed isolated activated partial thromboplastin time (aPTT) prolongation, lack of correction in the mixing study, reduced factor VIII activity (15.3%), and the presence of an inhibitor (0.7 Bethesda Units; BU). Based on the above, acquired hemophilia A was diagnosed. Treatment included recombinant activated factor VII (rFVIIa) for 6 days and corticosteroid therapy with methylprednisolone. Clinical improvement and nearcomplete remission were achieved, with normalization of aPTT, restoration of factor VIII activity (99.6%), and persistence of only trace inhibitor levels. This case highlights the diagnostic complexity of atypical postoperative bleeding, underscoring the need for a broad differential diagnosis and a high index of suspicion for rare disorders like acquired hemophilia A to ensure timely, life-saving intervention.

Keywords: ICU; acquired hemophilia A; case report; pancreaticoduodenectomy; postoperative bleeding.

PubMed Disclaimer

Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Diagnostic approach to isolated prolonged aPTT.
Figure 2.
Figure 2.
Timeline of the patient’s hospitalization.
Figure 3.
Figure 3.
Measurement of factor VIII inhibitor (Bethesda assay).
Figure 4.
Figure 4.
Relationship between residual factor VIII activity and Bethesda Units.
See this image and copyright information in PMC

References

    1. Hay CR, Brown S, Collins PW, Keeling DM, Liesner R. The diagnosis and management of factor VIII and IX inhibitors: a guideline from the United Kingdom Haemophilia Centre Doctors Organisation. Br J Haematol. 2006;133:591-605. - PubMed
    1. Knoebl P, Marco P, Baudo F, et al. Demographic and clinical data in acquired hemophilia A: results from the European acquired Haemophilia Registry (EACH2). J Thromb Haemost. 2012;10:622-631. - PubMed
    1. Collins PW, Hirsch S, Baglin TP, et al. Acquired hemophilia A in the United Kingdom: a 2-year national surveillance study by the United Kingdom Haemophilia Centre Doctors’ Organisation. Blood. 2007;109:1870-1877. - PubMed
    1. Franchini M, Lippi G. Acquired factor VIII inhibitors. Blood. 2008;112:250-255. - PubMed
    1. Ren Y, Jian T, Jian X, Yu G, Cui S. Diagnosis and treatment of acquired factor VIII deficiency: a case report and literature review. J Int Med Res. 2022;50:3000605221132882. - PMC - PubMed

Publication types

LinkOut - more resources