A rapidly progressive, life-threatening postpartum hemorrhage: successful treatment with anti-CD-20 monoclonal antibody.
BACKGROUND
Postpartum hemorrhage may be a life-threatening event and may result from coagulation defects.


METHODS
We report a case of a multigravida woman who developed rapidly progressive postpartum bleeding as a result of acquired factor VIII inhibitors. Repeated laparotomies and massive transfusions failed to achieve adequate control of bleeding. Laboratory studies revealed a prolonged activated partial thromboplastin time, and the presence of specific inhibitors was soon established. The patient responded only partially to steroids and immunotherapy. Upon administration of rituximab, an anti-CD-20 monoclonal antibody, control of bleeding was achieved.


CONCLUSIONS
Early diagnosis of acquired hemophilia as a rare cause of postpartum hemorrhage is crucial, because specific therapy may be life saving.
Mei-Dan
Elad
E
From the Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Hadera, Israel; and Israel National Hemophilia Center, Sheba Medical Center, Tel-Hashomer, Israel.
Walfisch
Asnat
A
Martinowitz
Uri
U
Hallak
Mordechai
M
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D005260:Female; D006467:Hemophilia A / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D006473:Postpartum Hemorrhage / Q000188:drug therapy* / Q000209:etiology*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D000069283:Rituximab
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab