Logo American Journal of Case Reports

Call: 1.631.629.4328
Mon-Fri 10 am - 2 pm EST

Contact Us

Logo American Journal of Case Reports Logo American Journal of Case Reports Logo American Journal of Case Reports

04 April 2016 : Case report  USA

A Hematological Menace: Multiple Venous Thrombosis Complicated by Acquired Factor VIII Deficiency

Challenging differential diagnosis, Unusual or unexpected effect of treatment, Rare disease

Robin PaudelEF, Luis W. DominguezEF, Prerna DograEF, Saurav SumanEF, Simon BadinF, Carrie WassermanEF

DOI: 10.12659/AJCR.895316

Am J Case Rep 2016; 17:214-218


BACKGROUND: Acquired hemophilia A (AHA) classically presents with spontaneous bleeding of mucosal sites, GI tract, and subcutaneous tissues, often leading to large hematomas and ecchymosis. Among documented cases, 50% are idiopathic and few have been associated with trauma or surgery. We present a case of life-threatening bleeding caused by AHA, following trauma and complicated by multiple venous thrombi.

CASE REPORT: A 21-year-old man presented with multiple injuries secondary to trauma leading to extensive life-saving surgery. Two weeks post-operatively, he developed multiple deep venous thrombi and was started on anticoagulation. Twenty-four days post-operatively, he started bleeding from multiple mucosal sites and developed an abdominal hematoma. Anticoagulation was stopped, with administration of fresh frozen plasma and vitamin K. Diagnosis of AHA was made based on low factor VIII level and presence of factor VIII inhibitors after an appropriate battery of tests ruled out other possible diagnoses. He was started on steroids and recombinant factor VIIa, leading to immediate improvement. Once stable, Rituximab infusions resulted in decreasing factor VIII inhibitor levels, with gradual normalization of PTT.

CONCLUSIONS: AHA remains a diagnostic challenge because of its rarity, leading to delay in diagnosis and causing significant morbidity and mortality. Elevated PTT relative to PT/INR is a strong clue which should be followed by mixing studies. Very few cases have been associated with surgery or trauma and relatively few large, controlled trials have compared different treatment modalities for AHA. Growing evidence supports anti-CD20 (Rituximab) as an effective treatment option, as in this case.

Keywords: Factor VIIa - therapeutic use, Glucocorticoids - therapeutic use, Hemophilia A - therapy, Immunologic Factors - therapeutic use, Multiple Trauma - surgery, Postoperative Complications, Recombinant Proteins - therapeutic use, Rituximab - therapeutic use, Venous Thrombosis - therapy, young adult

Add Comment 0 Comments

In Press

Case report  Portugal

Bartter Syndrome Presenting as Arginine-Vasopressin Resistance: A Report of 2 Cases

Am J Case Rep In Press; DOI: 10.12659/AJCR.942872  

Case report  China (mainland)

Extended Left Hemihapatectomy with Right Hepatic Artery Reconstruction for Primary Hepatic Neuroendocrine N...

Am J Case Rep In Press; DOI: 10.12659/AJCR.943721  

Case report  Austria

Smoking-Associated Endotracheal Hair Growth: A Case Report on Tracheal Complications

Am J Case Rep In Press; DOI: 10.12659/AJCR.943909  

Case report  Japan

Virtual Reality-Guided Simulation for Percutaneous Coronary Intervention in a Patient with Anatomical Anoma...

Am J Case Rep In Press; DOI: 10.12659/AJCR.944485  

Most Viewed Current Articles

07 Mar 2024 : Case report  USA 38,124

Neurocysticercosis Presenting as Migraine in the United States

DOI :10.12659/AJCR.943133

Am J Case Rep 2024; 25:e943133


10 Jan 2022 : Case report  Germany 31,073

A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV...

DOI :10.12659/AJCR.935263

Am J Case Rep 2022; 23:e935263

19 Jul 2022 : Case report  Saudi Arabia 17,693

Atlantoaxial Subluxation Secondary to SARS-CoV-2 Infection: A Rare Orthopedic Complication from COVID-19

DOI :10.12659/AJCR.936128

Am J Case Rep 2022; 23:e936128

23 Feb 2022 : Case report  USA 17,607

Penile Necrosis Associated with Local Intravenous Injection of Cocaine

DOI :10.12659/AJCR.935250

Am J Case Rep 2022; 23:e935250

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923