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CC BY-NC-ND 4.0 · AJP Rep 2023; 13(04): e85-e88
DOI: 10.1055/a-2198-7888
Case Report

Acquired Hemophilia A: A Rare, Acquired Coagulopathy in the Postpartum Setting

Austin Oberlin 
1   Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
,
Nicole M. Krenitsky
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
,
Christy Gandhi
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
,
Imo Joseph Akpan
3   Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
,
Andrew Eisenberger
3   Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
,
Ruth Landau
4   Department of Anesthesia, Columbia University Irving Medical Center, New York, New York
,
Ladin Yurteri-Kaplan
5   Division of Gynecologic Specialty Surgery, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
,
Lisa Nathan
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
,
Jean-Ju Sheen
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
,
Anita LaSala
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
,
Mary D'Alton
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
› Author Affiliations Funding None.
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Abstract

Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity. Pregnancy-associated acquired hemophilia A (AHA) caused by autoantibodies against factor VIII can present with recurrent episodes of postpartum bleeding.

Case 1 A 50-year-old G2P0112 presented with vaginal bleeding 22 days postcaesarean. She underwent dilation and curettage, hysterectomy, and interventional radiology (IR) embolization before AHA diagnosis. She was hospitalized for 32 days and received 23 units of blood product. She remains without relapse of AHA after 5 years.

Case 2 A 48-year-old G3P1021 presented with vaginal bleeding 8 days postcaesarean. She underwent three surgeries and IR embolization before AHA diagnosis. She was hospitalized for 18 days and received 39 units of blood product. Prednisone and cyclophosphamide were continued after discharge.

AHA is a rare cause of PPH. An isolated prolonged activated partial thromboplastin time (aPTT) should prompt further workup in postpartum patients with refractory bleeding. Rapid recognition of AHA can prevent significant morbidity related to hemorrhage, massive transfusion, and multiple surgeries.

Keywords

postpartum hemorrhage - bleeding disorder - coagulopathy - maternal morbidity


Publication History

Received: 24 February 2023

Accepted: 19 October 2023

Accepted Manuscript online:
25 October 2023

Article published online:
28 November 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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