Doxycycline-induced acquired haemophilia A

Area of Science:

• Hematology
• Pharmacology

Background:

• Acquired hemophilia A (AHA) is a rare autoimmune disorder characterized by autoantibodies against factor VIII.
• Drug-induced AHA is exceptionally uncommon, with limited documented cases.

Observation:

• An 80-year-old male presented with extensive bruising and hematomas following doxycycline administration.
• Initial laboratory findings revealed coagulopathy, significant anemia, elevated activated partial thromboplastin time, and low factor VIII levels with high factor VIII inhibitors.

Findings:

• The patient was diagnosed with acquired hemophilia A, likely triggered by doxycycline.
• Treatment with corticosteroids, cyclophosphamide, rituximab, and recombinant factor VIIa led to an increase in factor VIII levels and hemoglobin stabilization.
• Despite treatment, the patient developed severe COVID-19 pneumonia and acute respiratory distress syndrome, ultimately succumbing to respiratory failure.

Implications:

• This case highlights a rare potential adverse effect of doxycycline, precipitating acquired hemophilia A.
• It underscores the importance of considering drug-induced coagulopathies in patients presenting with unexplained bleeding.
• The complex management and poor outcome emphasize the challenges associated with AHA, particularly in elderly patients with comorbidities.