Unsuspected Acquired Hemophilia in a Patient with Severe Postpartum Hemorrhage
Yeshita V Pujar, Bhavana Y Sherigar, Shobhana Patted, BR Desai, Jayashree Ruge
Citation Information :
Pujar YV, Sherigar BY, Patted S, Desai B, Ruge J. Unsuspected Acquired Hemophilia in a Patient with Severe Postpartum Hemorrhage. Int J Infertil Fetal Med 2011; 2 (1):41-43.
A 24-year-old healthy multigravid patient developed postpartum hemorrhage 3 days post normal delivery. She underwent curettage × 3 followed by laparotomy and hysterectomy. Postoperatively she developed a subrectus hematoma that required laparotomy and drainage. Persistent bleeding per vaginum prompted a third laparotomy for internal iliac ligation, which could not be carried out due to massive retroperitoneal hematoma. She received multiple transfusions of blood and blood products. Her APTT was prolonged but DIC screen was negative. Prolonged APTT was not corrected by addition of normal plasma. This pointed to autoantibodies to factor VIII. She responded to immunosuppression with prednisolone and cyclophosphamide.
Postpartum haemorrhage: A continuing problem. Br J Obstet Gynaecol 1987;94:67-71.
Managing complications in pregnancy and childbirth. Maternal mortality in 2000: Estimates developed by WHO, UNICEF and UNFPA. Geneva: World Health Organization, Department of Reproductive Health and Research (RHR) 2003.
Ministry of Health and Family Welfare, Government of India, New Delhi.
Incidence of circulating anticoagulants in normal population. Acta haematol 1982;67:217-19.
Acquired haemophilia: A natural history study of 16 patients with factor VIII inhibitors receiving little or no therapy. Arch Intern Med 1987;147:1077-81.
The treatment of acquired factor VIII inhibitors: Worldwide experience with porcine factor VIII concentrate. Semin Hematol 19933022-2. (Suppl 1).
Treatment of acquired Hemophilia. Semin Hematol 1994;31:16-19 (Suppl 4).
Acquired haemophilia and its treatment. Br J Haematol 1995; 89:231-236.
A survey of 215 non-hemophilic patients with inhibitors to factor VIII. Thromb Haemost 1981;45:200-03.
Acquired hemophilia A in women Postpartum: Clinical manifestations, diagnosis, and treatment. Clinical and applied thrombosis/hemostasis 2000;6:82-86.
Use of porcine factor VIII in the treatment of patients with acquired hemophilia. Blood 1993;81:1513-20.
Acute abdominal pain due to an acquired disorder of coagulation. British Medical Journal 1998;296:1460-61.
Post-partum factor VIII inhibitors: A review of the literature with special reference to the value of steroid and immunosuppressive treatment. Thrombosis and Haemostasis 1995;73:1-5.
Postpartum acquired factor VIII inhibitors: Results of a survey. American Journal of Haematology 1998;59:1-4.
Acquired haemophilia A in women post-partum: Management of bleeding episodes and natural history of the factor VIII inhibitor. European Journal of Haematology 1997;59:105-18.
Acquired haemophilia, An unusual cause of severe postpartum haemorrhage. British Journal of Obstetrics and Gynaecology 1997;104:854-56.
Human coagulation factor FVIIa (recombinant) in the management of limb-threatening bleeds unresponsive to alternative therapies: Results form the NovoSeven emergency-use programme in patients with severe haemophilia or with acquired inhibitors. Blood Coagul Fibrinolysis 2000;11:255-59.
Treatment of refractory autoimmune (acquired) haemophilia with anti-CD20 (rituximb). Br J Haematol 2002;119:578.
Rituximab in the treatment of acquired factor VIII inhibitors. Blood 2002;100:3426-28.
Normal pregnancy in a patient with a prior postpartum factor VIII inhibitor, with observations on pathogenesis and prognosis. Blood 1981;58:619-24.
