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Lena Bick1, Uffe Mark Lauritzen2, Sofie Andersen1

  • 1Anæstesiologisk Afdeling, Sygehus Lillebælt, Vejle Sygehus.

Ugeskrift for Laeger
|January 9, 2023
PubMed
Summary

Acquired haemophilia A (AHA) is a rare autoimmune bleeding disorder. This case highlights AHA in an elderly male on rivaroxaban, presenting with a life-threatening airway hematoma.

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Area of Science:

  • Internal Medicine
  • Hematology
  • Autoimmune Disorders

Background:

  • Acquired haemophilia A (AHA) is a rare, life-threatening autoimmune condition.
  • It arises from autoantibodies inhibiting coagulation factor VIII.
  • AHA should be suspected in patients with spontaneous bleeding and prolonged activated partial thromboplastin time (APTT).

Observation:

  • This case report details a 75-year-old male diagnosed with AHA.
  • The patient presented with supraglottic hematoma, necessitating intubation due to breathing and swallowing difficulties.
  • The patient was concurrently undergoing anticoagulant therapy with rivaroxaban.

Findings:

  • The patient's presentation of spontaneous, severe bleeding with no prior history was indicative of AHA.
  • The presence of rivaroxaban complicated the diagnosis and management of the bleeding event.
  • Prompt recognition and management of AHA are critical for patient outcomes.

Implications:

  • This case underscores the importance of considering AHA in elderly patients presenting with unexplained bleeding, even with anticoagulant use.
  • It highlights the diagnostic challenges and management complexities of AHA, particularly when co-occurring with anticoagulant therapy.
  • Early diagnosis and appropriate treatment strategies are crucial to mitigate the severe morbidity and mortality associated with AHA.

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