Acquired hemophilia A manifesting as plasma transfusion-uncontrolled severe bleeding 2 weeks after chorioamnionitis-induced abortion.
Acquired hemophilia A (AHA) is a serious and rare complication of pregnancy, caused by autoantibodies to coagulation factor VIII after delivery. We here report the case of a 36-year-old primigravida woman who developed AHA following chorioamnionitis-caused miscarriage in the second trimester. Thirteen days after abortion, sudden, massive vaginal bleeding occurred with marked prolongation of activated partial thromboplastin time (APTT) in the absence of other abnormal coagulation data. Sequential transfusion of fresh frozen plasma did not achieve normalization of APTT. Further examination confirmed reduction of coagulation factor VIII and the presence of its inhibitor, leading to the final diagnosis of AHA. The patient was effectively treated with bypassing agents (activated prothrombin complex concentrate and recombinant activated factor VII) and immunosuppressive therapy. Fifteen months after remission, the patient became pregnant and successfully achieved term delivery with no signs of recurrence. This case illustrates that AHA should be considered in the occurrence of plasma transfusion-uncontrolled severe bleeding after delivery.
Department of Obstetrics and Gynecology, Ishikawa Medical Center for Maternal and Child Health, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.|Department of Obstetrics and Gynecology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Ayumi
A
Matsuoka
Department of Obstetrics and Gynecology, Ishikawa Medical Center for Maternal and Child Health, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
Hiromasa
H
Sasaki
Department of Hematology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
Chiharu
C
Sugimori
Department of Obstetrics and Gynecology, Ishikawa Medical Center for Maternal and Child Health, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
Shinya
S
Hirabuki
Department of Obstetrics and Gynecology, Ishikawa Medical Center for Maternal and Child Health, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
Tsutomu
T
Hoshiba
Department of Obstetrics and Gynecology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Hiroshi
H
Fujiwara
D000028:Abortion, Induced; D000328:Adult; D002821:Chorioamnionitis; D005260:Female; D006467:Hemophilia A / Q000097:blood* / Q000150:complications; D006801:Humans; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood*
acquired hemophilia A; chorioamnionitis; factor VIII inhibitor; plasma transfusion; post-partum hemorrhage