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An unusual cause of bruising in an 80-year-old woman
J Kelly1, M Gattens, R Geraghty
1Department of Medicine for the Elderly, Queen Mary's Hospital, Sidcup, Kent, UK.
Presentation:
a previously fit 80-year-old woman presented with a 2-week history of spontaneous and extensive bruising affecting all four limbs. The severity was such that she required a transfusion of 8 units of blood.
Results Of Investigations:
a markedly prolonged activated partial thromboplastin time which was only partially corrected with normal plasma; tests for lupus anticoagulant were negative. Factor VIII levels were reduced and the Bethesda assay indicated an acquired inhibitor to factor VIII. She was treated with a combination of intravenous immunoglobulin and immunosuppression.
Outcome:
the response to treatment was excellent, with a marked reduction in anti-factor VIII antibody levels and resolution of the bruising over the next few weeks.