The objective of this study was to determine the prevalence and clinical significance of elevated antiphospholipid antibodies (APA) in a large series of patients admitted to a departament of Internal Medicine. At the end of entry phase, 1014 patients were tested (488 males-526 females, mean age: 66,7 years, range 18-97). Seventy-two (7.1 %) patients were found APA positive at least once: 44 males and 28 females, mean age 69 years, range 23 to 94. Twenty fulfilled the criteria of Primary Antiphospholipid Antibody Syndrome: 10 patients were referred for deep vein thrombosis, 3 had history of deep vein thrombosis, 1 had both arterial thrombosis and a history of venous thrombosis; 2 had thrombocytopenia; 3 had stroke, 1 had a history of s troke. One patient had SLE according to ARA classification. The most frequent associated disease was cancer: 14 patients, 9 had evolutive malignant disease, 5 were in clinical remission of neoplasia. Other clinical conditions included chronic and/or acute alcoholic intoxication (n=8), severe atherosclerosis (n=4), leg ulcer (n=4). Insufficient data are available about the evolution, but 7 patients died in the year following diagnosis. Eight patients had fluctuations in APA detection: 2 initially APA positive became negative, 5 initially negative became positive and 1 patient was alternatively positive, negative and positive without steroid treatment. Thus, as expected, APA occur in a variety of clinical disorders. The association with cancer or alcoholic intoxication deserves further investigations.

Acquired haemophilia is a rare but life‐threatening bleeding disease that can be observed in males or females at various ages. In the present study, we report on five cases of acquired factor (F) VIII inhibitors diagnosed in the elderly population over a period of 5 years between 1995 and 1999 in our hospital. The median age of the patients at the time of diagnosis was 76.2 years (66–92 years). In all cases, the diagnosis was suggested by mild to severe bleeding with no previous bleeding history. While the absence of associated conditions is frequently reported especially among the elderly, in our series an underlying disease was found in four out of the five cases: kidney tumour (two cases) and autoimmune disease (two cases). The bleeding was controlled in four patients using porcine FVIII (two cases) or recombinant FVIIa (two cases). The inhibitors were completely resolved in two patients (kidney tumour, GoodPasture syndrome) by treatment of the underlying disease. However, three patients died as direct or indirect consequence of having an inhibitor. Our series confirms and extends previous data reporting the complexity and severity of this disorder. Because bleeding is often severe, a prompt and correct diagnosis is required to provide adequate therapeutic options that take the advanced age of the patients into account.

For a long time, physical activities have been contraindicated in haemophiliacs or were restricted to few activities. Sports are nowadays advocated for haemophiliacs. Although various lists of physical activities have been proposed, scuba diving is never mentioned. Thus, with a group of haemophilic volunteers, a study was launched on whether, with strict medical follow-up, scuba diving could be allowed for patients with haemophilia. All the participants followed a training program including theory and assessment. In 6 years, a total of 517 dives were performed by 20 patients with congenital bleeding disorders. Nine were under prophylaxis for haemophilia, and nine received on-demand treatment. Two patients had type I von Willebrand's disease. Among the 20 patients, 12 made 12-153 dives, whereas six made eight dives each. No incident was noted during or after the dives. Thus, scuba diving can be authorized for PWH, if they have none of the specific medical contraindications for diving and if they have received medical training allowing them to manage their disease themselves.

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