title: Acquired hemophilia A in the United Kingdom: a 2-year national surveillance study by the United Kingdom Haemophilia Centre Doctors' Organisation.
abstract: Acquired hemophilia A is a severe bleeding disorder caused by an autoantibody to factor VIII. Previous reports have focused on referral center patients and it is unclear whether these findings are generally applicable. To improve understanding of the disease, a 2-year observational study was established to identify and characterize the presenting features and outcome of all patients with acquired hemophilia A in the United Kingdom. This allowed a consecutive cohort of patients, unbiased by referral or reporting practice, to be studied. A total of 172 patients with a median age of 78 years were identified, an incidence of 1.48/million/y. The cohort was significantly older than previously reported series, but bleeding manifestations and underlying diseases were similar. Bleeding was the cause of death in 9% of the cohort and remained a risk until the inhibitor had been eradicated. There was no difference in inhibitor eradication or mortality between patients treated with steroids alone and a combination of steroids and cytotoxic agents. Relapse of the inhibitor was observed in 20% of the patients who had attained first complete remission. The data provide the most complete description of acquired hemophilia A available and are applicable to patients presenting to all centers.
authors.affiliation: University Hospital of Wales and School of Medicine, Cardiff University, United Kingdom. peter.collins@cardiffandvale.wales.nhs.uk
authors.forename: Peter W
authors.initials: PW
authors.lastname: Collins
authors.forename: Sybil
authors.initials: S
authors.lastname: Hirsch
authors.forename: Trevor P
authors.initials: TP
authors.lastname: Baglin
authors.forename: Gerard
authors.initials: G
authors.lastname: Dolan
authors.forename: John
authors.initials: J
authors.lastname: Hanley
authors.forename: Michael
authors.initials: M
authors.lastname: Makris
authors.forename: David M
authors.initials: DM
authors.lastname: Keeling
authors.forename: Ri
authors.initials: R
authors.lastname: Liesner
authors.forename: Simon A
authors.initials: SA
authors.lastname: Brown
authors.forename: Charles R M
authors.initials: CR
authors.lastname: Hay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006467:Hemophilia A / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D006470:Hemorrhage / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012955:Societies, Medical; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D007166:Immunosuppressive Agents