Mysterious bruises

• Main Authors: H Chen, J Jiao, C P Cheung, S Borra
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2012-01-01
• Series: Journal of Postgraduate Medicine
• Subjects: Acquired hemophilia A; autoimmune disorders; diagnosis; pernicious anemia; treatment
• Online Access: http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2012;volume=58;issue=3;spage=221;epage=224;aulast=Chen
• ISSN: 0022-3859; 0972-2823

A 69-year-old man presented with multiple spontaneous bruises in the past 2 weeks. Several large-sized hematomas were found on examination. The initial investigation revealed a prolonged activated partial thromboplastin time (aPTT) with normal platelet count and international normalized ratio. Further investigation revealed a low factor VIII activity secondary to presence of factor VIII inhibitor, making the diagnosis of acquired hemophilia A. Further work-up revealed that pernicious anemia was present and acted as an associated disease. After steroids therapy, his aPTT was normalized and the factor VIII inhibitor titer became undetectable. 2 months later, a relapse occurred and new hematomas appeared at his retropharyngeal space and left arm. His bleeding was controlled by administration of recombinant factor VIIa, and a combined therapy of intravenous steroids and rituximab was given to eradicate the inhibitor. The approach to workup of bleeding disorders as well as treatment of acquired hemophilia A are herein discussed.