J Acute Care Surg.  2019 Oct;9(2):72-75. 10.17479/jacs.2019.9.2.72.

Spontaneous Retroperitoneal Hemorrhage Caused by Idiopathic Acquired Hemophilia A Misdiagnosed as a Delayed Traumatic Hematoma: A Case Report

• Kim SH
• Park SJ
• Park CI
• Choi SU
• Kim JH

• KMID: 2464988
• DOI: http://doi.org/10.17479/jacs.2019.9.2.72

Abstract

Acquired hemophilia A (AHA) is a rare disease where typically coagulation factor VIII is inhibited by autoantibodies. It occurs in patients with no personal or familial history of bleeding. In this case study a 61-year-old male presented with a huge psoas hematoma. He had no history of bleeding disorders. He was initially diagnosed with delayed traumatic hematoma. Despite conservative and surgical treatments, coagulopathy was not resolved and postoperative bleeding continued. Consequently, coagulation factor tests were performed and showed reduced activity of factor VIII (2.7%). In addition, factor VIII inhibitor was detected. The patient was diagnosed with AHA and administered recombinant factor VIII for 3 days which resulted in the cessation of bleeding. AHA can lead to a life-threatening hemorrhage, and needs to be considered in differential diagnoses in any patients presenting with unexplained and repeated bleeding, where there is no personal or familial history of bleeding disorders.

Keyword

autoantibodies; blood coagulation disorders; factor VIII; hematoma; hemophilia A

MeSH Terms

Autoantibodies
Blood Coagulation Disorders
Blood Coagulation Factors
Diagnosis, Differential
Factor VIII
Hematoma*
Hemophilia A*
Hemorrhage*
Humans
Male
Middle Aged
Rare Diseases
Autoantibodies
Blood Coagulation Factors
Factor VIII