Clinical communicationAcquired factor VIII inhibitor presenting as a tongue hematoma☆
Introduction
Emergency physicians frequently encounter patients with life threatening bleeding and occasionally need to treat patients with bleeding and underlying coagulopathy. Acquired hemophilia, although a relatively rare disorder, may result in devastating consequences for a patient with acute hemorrhage if unrecognized and untreated. We report a case of undiagnosed acquired hemophilia due to factor VIII inhibitor and review the diagnosis, acute management and briefly summarize long term management options.
Section snippets
Case presentation
A 74-year-old African-American woman presented to the Emergency Department (ED) with swelling of the tongue extending into the neck of 3 days duration (Figure 1). The patient had difficulty swallowing and could not speak clearly but denied respiratory distress. There was no history of trauma. The past medical history was significant for hypertension and asthma. The past surgical history included a nasal polypectomy as a teenager, total abdominal hysterectomy in her 30s, and right hip
Discussion
Acquired hemophilia is a rare disorder associated with potentially serious bleeding complications. The incidence is estimated to be 1 per million persons per year (1). In contrast to congenital hemophilia, acquired hemophilia is distributed equally between men and women and is most common in persons over 60 years of age. When the disease occurs in elderly patients it has been associated with connective tissue or autoimmune disease, malignancy, asthma, cutaneous disorders, or drugs such as
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Cited by (5)
Localised giant haematoma and subsequent widespread purpura as a sign of acquired haemophilia A
2013, Australasian Journal of DermatologyAcquired hemophilia A presenting in an elderly man
2007, CMAJ. Canadian Medical Association JournalSuccessful treatment of upper airway obstruction caused by hemorrhage in patients with inhibitor hemophilia
2007, Gematologiya i TransfusiologiyaFactor VIII ectopically targeted to platelets is therapeutic in hemophilia A with high-titer inhibitory antibodies
2006, Journal of Clinical Investigation
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Clinical Communications (Adults) is coordinated by Ron Walls, md, of Brigham and Women's Hospital and Harvard University Medical School, Boston, Massachusetts