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| GRAND ROUND CASE |
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| Year : 2012 | Volume
: 58
| Issue : 3 | Page : 221-224 |
Mysterious bruises
H Chen, J Jiao, CP Cheung, S Borra
Department of Medicine, Kingsbrook Jewish Medical Center, Brooklyn, NY, USA
Correspondence Address:
S Borra
Chief of Nephrology, Medical Coordinator, Kingsbrook Jewish Medical Center, Brooklyn, NY
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0022-3859.101643
A 69-year-old man presented with multiple spontaneous bruises in the past 2 weeks. Several large-sized hematomas were found on examination. The initial investigation revealed a prolonged activated partial thromboplastin time (aPTT) with normal platelet count and international normalized ratio. Further investigation revealed a low factor VIII activity secondary to presence of factor VIII inhibitor, making the diagnosis of acquired hemophilia A. Further work-up revealed that pernicious anemia was present and acted as an associated disease. After steroids therapy, his aPTT was normalized and the factor VIII inhibitor titer became undetectable. 2 months later, a relapse occurred and new hematomas appeared at his retropharyngeal space and left arm. His bleeding was controlled by administration of recombinant factor VIIa, and a combined therapy of intravenous steroids and rituximab was given to eradicate the inhibitor. The approach to workup of bleeding disorders as well as treatment of acquired hemophilia A are herein discussed.
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