Unexpected bleeding following eyelid tumor resection leading to the rare diagnosis of acquired haemophilia.
BACKGROUND
Our goal is to report for the first time in the literature a case of uncontrolled bleeding after an oculoplastic surgical procedure leading to the diagnosis of acquired haemophilia.


METHODS
An 82-year-old patient underwent tumor excision and reconstruction of his right lower eyelid. On the same day, uncontrolled bleeding occurred that resisted optimal blood pressure control, external compression, surgical haemostasis and wound revision. Usual coagulation screening tests were normal, except for a slightly prolonged activated partial thromboplastin time.


RESULTS
Extensive coagulation check was performed, which showed a severely reduced factor VIII due to the presence of an inhibitor. The bleeding was immediately stopped after administration of recombinant factor VIIa. After healing of the wound, factor VIIa treatment was replaced by immunosuppressive therapy. The factor VIII inhibitor became unmeasurable and remained so for three months after stopping the immunosuppressive therapy.


CONCLUSIONS
Ophthalmologists confronted with unexpected uncontrolled bleeding should think about the possibility of blood dyscrasia, in particular acquired haemophilia.
Mormile
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Jules Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland. s_mormile@yahoo.com
Marbet
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Haefliger
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D000369:Aged, 80 and over; D005142:Eyelid Neoplasms / Q000150:complications* / Q000601:surgery*; D006467:Hemophilia A / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D008297:Male; D019106:Postoperative Hemorrhage / Q000175:diagnosis* / Q000209:etiology*; D035583:Rare Diseases / Q000175:diagnosis / Q000209:etiology