Refractory acquired haemophilia A in a patient with HIV treated with Emicizumab

Acquired haemophilia is a rare coagulopathy characterized by acquired inhibitors directed against clotting factors resulting in bleeding episodes. A middle-aged woman with HIV developed refractory haemophilia with bleeding episodes resulting in recurrent hospitalizations despite several rounds of bypassing agents and several lines of immunosuppressive agents. She was eventually successfully treated with Emicizumab and has not had any major bleeding episodes for 3 years since initiation of this treatment. Emicizumab, which is a bispecific, FVIII-mimetic therapeutic antibody, has considerably reduced the annualized bleeding rates in congenital haemophiliacs with and without inhibitors and should be considered as an agent for acquired haemophilia to reduce recurrent bleeding episodes and even decrease inhibitor titer.