Acquired Hemophilia A in a Patient With Multiple Sclerosis

Area of Science:

• Hematology
• Neurology
• Immunology

Background:

• Acquired hemophilia A (AHA) is a rare autoimmune bleeding disorder targeting clotting factor VIII.
• It predominantly affects the elderly and is linked to various conditions, but often remains idiopathic.
• AHA is exceptionally rare in patients with multiple sclerosis (MS).

Observation:

• A 56-year-old patient with a history of MS presented with symptoms of bleeding, including thigh and arm swelling.
• Imaging confirmed a significant iliopsoas hematoma.
• Laboratory tests revealed prolonged activated partial thromboplastin time (aPTT) unresponsive to mixing studies, low factor VIII activity, and elevated inhibitors.

Findings:

• The diagnostic workup confirmed Acquired hemophilia A in the patient with multiple sclerosis.
• The patient's presentation of bleeding and laboratory results were consistent with AHA.
• Treatment involved factor eight inhibitor bypassing agents, rituximab, and steroids.

Implications:

• AHA should be considered in patients presenting with new-onset bleeding and prolonged aPTT, irrespective of other conditions.
• Early diagnosis and intervention in AHA are critical due to its high mortality rate.
• This case highlights a rare association between multiple sclerosis and acquired hemophilia A, emphasizing the need for vigilance in diagnosis.