Journal of Postgraduate Medicine
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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

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.

How to cite this article:
Chen H, Jiao J, Cheung C P, Borra S. Mysterious bruises.J Postgrad Med 2012;58:221-224

How to cite this URL:
Chen H, Jiao J, Cheung C P, Borra S. Mysterious bruises. J Postgrad Med [serial online] 2012 [cited 2023 Oct 2 ];58:221-224
Available from:;year=2012;volume=58;issue=3;spage=221;epage=224;aulast=Chen;type=0

Monday, October 2, 2023
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