title: Acquired haemophilia A: an unusual postoperative complication.
abstract: An African-American man aged 65 years with multiple malignancies in remission was admitted for small bowel obstruction. He was treated with laparotomy following failure of conservative management. Postoperatively, he developed intra-abdominal bleed, which persisted, despite surgical haematoma evacuation. Further haematological workup revealed isolated prolongation of activated partial thromboplastin time (aPTT) with reduced factor VIII (FVIII) activity and raised FVIII inhibitor titre. Assuming acquired haemophilia A (AHA), FVIII inhibitor bypassing activity and corticosteroids were started with subsequent resolution of the bleeding from the surgical site. The patient remained free of bleeding episodes at 3-month follow-up and the aPTT normalised. This case report highlights the association of surgery with AHA and summarises the treatments with underlying mechanisms.
authors.affiliation: University of Alabama School of Medicine, Montgomery, Alabama, USA.
authors.forename: Sumant
authors.initials: S
authors.lastname: Arora
authors.affiliation: Department of Hematology/Oncology, Mayo Clinic Rochester, Minnesota, USA.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Goyal
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Rehan
authors.initials: R
authors.lastname: Sarmad
authors.affiliation: University of Alabama School of Medicine, Montgomery, Alabama, USA.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Wool
mesh_terms: D000005:Abdomen / Q000473:pathology; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D019774:Blood Coagulation Factor Inhibitors / Q000097:blood*; D005169:Factor VIII / Q000378:metabolism*; D006467:Hemophilia A / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery; D008297:Male; D010314:Partial Thromboplastin Time; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage
chemical_list: D000305:Adrenal Cortex Hormones; D019774:Blood Coagulation Factor Inhibitors; D005169:Factor VIII