Attah Abraham, Huffman Deanna, Asawa Palash, Edlukudige Keshava Vinay, Shah Deep
Allegheny Health Network, Internal Medicine Department, Pittsburgh, PA 15212, USA.
Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, USA.
J Med Cases. 2024 Jun;15(6):106-109. doi: 10.14740/jmc4199. Epub 2024 May 25.
Acquired hemophilia A (AHA) is a clotting disorder characterized by the presence of neutralizing antibodies that inhibit factor VIII, resulting in increased bleeding risk. Known etiologies include malignancy, autoimmune conditions, graft-vs-host disease, and more recently coronavirus disease 2019 (COVID-19) infection. In this case report, we describe an 86-year-old female who was found to have AHA incidentally during preoperative workup for meningioma resection. She was subsequently found to have COVID-19 infection which was the likely cause of her development of AHA. She was treated with factor eight inhibitor bypassing agent (FEIBA) and recombinant factor VII (rVII) for a small hematoma on her right arm along with prednisone and cyclophosphamide. She then developed disseminated intravascular coagulation (DIC) initially secondary to FEIBA and subsequently rFVII. DIC resolved after these factor concentrates were withheld. The aim of this case report was to emphasize the importance of monitoring partial thromboplastin time (PTT) in patients with COVID-19 and proceeding with AHA workup if indicated. It is also imperative to know and understand the potentially life-threatening, albeit rare, adverse effects of DIC associated with the administration of factor concentrates, especially in the elderly population and withholding these factor concentrates once DIC is suspected.
获得性血友病A（AHA）是一种凝血障碍性疾病，其特征是存在抑制凝血因子VIII的中和抗体，导致出血风险增加。已知的病因包括恶性肿瘤、自身免疫性疾病、移植物抗宿主病，以及最近的2019冠状病毒病（COVID-19）感染。在本病例报告中，我们描述了一名86岁女性，她在脑膜瘤切除术前检查时偶然发现患有AHA。随后发现她感染了COVID-19，这可能是她发生AHA的原因。她因右臂小血肿接受了凝血因子VIII抑制物旁路制剂（FEIBA）和重组凝血因子VII（rVII）治疗，同时使用了泼尼松和环磷酰胺。随后她发生了弥散性血管内凝血（DIC），最初继发于FEIBA，随后继发于rFVII。停用这些凝血因子浓缩物后，DIC得到缓解。本病例报告的目的是强调在COVID-19患者中监测部分凝血活酶时间（PTT）的重要性，并在有指征时进行AHA检查。了解并认识到与凝血因子浓缩物给药相关的DIC潜在的危及生命（尽管罕见）的不良反应也至关重要，尤其是在老年人群中，一旦怀疑发生DIC，应停用这些凝血因子浓缩物。
