Surgery-associated acquired hemophilia A.
We present two patients who acquired factor VIII antibodies in the immediate postoperative period. One patient was receiving warfarin that was temporarily discontinued but reintroduced after the procedure. Preoperatively, none gave a history of bleeding, even with past surgeries, and both had normal coagulation tests. Within days of surgery, hemorrhage with prolonged activated partial thromboplastin time, low factor VIII levels, and demonstrable factor VIII antibodies were observed. For the patient who was receiving warfarin the severe bleeding was attributed, at the beginning, only to the high international normalized ratio (INR), which resulted in a fatal delay in diagnosis and appropriate treatment. We would like to raise awareness of surgery as a precipitating cause of acquired hemophilia, which is something to be considered with unusual postoperative bleeding. This syndrome is remarkable for its abrupt onset within days of surgery, severe bleeding but potential successful outcome with combined hemostatic control with recombinant activated FVII (rFVIIa) and elimination of the antibody by immunosuppression.
Theodossiades
G
G
First Regional Transfusion and Haemophilia Centre, Hippokration Hospital, Athens, Greece. blood@hellasnet.gr
Tsevrenis
V
V
Nomikou
E
E
Dadiotis
L
L
Kontopoulou-Griva
I
I
D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000096:biosynthesis; D005169:Factor VIII / Q000276:immunology; D005260:Female; D006467:Hemophilia A / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D014859:Warfarin / Q000627:therapeutic use
D001323:Autoantibodies; D014859:Warfarin; D005169:Factor VIII