title: Acquired hemophilia complicated by cardiorenal syndrome type 3.
abstract: Development of autoantibodies against coagulation factor VIII (FVIII) leads to a rare condition defined as acquired hemophilia (AH). If not diagnosed and treated early, AH may be associated with high mortality and morbidity. A 65-year-old woman presented with history of macrohematuria, acute renal failure, cardiogenic shock, and acute respiratory failure. Blood investigation revealed azotemia, prolonged activated partial thromboplastin time (aPTT), coagulation FVIII level of <1%, and presence of FVIII inhibitor. Echocardiography showed global hypokinesia and ultrasonography and computed tomography (CT) revealed bilateral hydroureteronephrosis. The final diagnosis was acquired hemophilia A, complicated by acute obstructive renal failure and cardiorenal syndrome (CRS) type 3. Patient was managed with mechanical ventilation, heparin-free hemodialysis, negative fluid balance, recombinant activated factor VII, and prednisolone. Hematuria was relieved, renal function improved, and cardiac function showed improvement on repeat echocardiography. Patient was discharged on prednisolone with subsequent follow ups.
authors: Department of Critical Care Medicine, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India.
authors: Rakesh
authors: R
authors: Sharma
authors: Department of Critical Care Medicine, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India.
authors: Sananta Kumar
authors: SK
authors: Dash
authors: Department of Critical Care Medicine, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India.
authors: Rajesh
authors: R
authors: Chawla
authors: Department of Critical Care Medicine, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India.
authors: Sudha
authors: S
authors: Kansal
authors: Department of Nephrology, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India.
authors: Devender Kumar
authors: DK
authors: Agrawal
authors: Department of Hematology, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India.
authors: Harsh
authors: H
authors: Dua
keywords: Acquired hemophilia; cardiorenal syndrome; factor VIII inhibitor; recombinant activated factor VII