A Case of a Patient Who Is Diagnosed with Mild Acquired Hemophilia A after Tooth Extraction Died of Acute Subdural Hematoma due to Head Injury

Abstract

Background Acquired hemophilia A (AHA) is a rare disorder which results from the presence of autoantibodies against blood coagulation factor VIII. The initial diagnosis is based on the detection of an isolated prolongation of the activated partial thromboplastin time (aPTT) with negative personal and family history of bleeding disorder. Definitive diagnosis is the identification of reduced FVIII levels with evidence of FVIII neutralizing activity. Case report We report a case of a 93-year-old female who was diagnosed as AHA after tooth extraction at her home clinic. Prolongation of aPTT and a reduction in factor VIII activity levels were observed with the presence of factor VIII inhibitor. AHA condition is mild. However, acute subdural hematoma of this patient occurred due to an unexpected accident in our hospital. Hematoma was gradually increased and the patient died 13 days after admission. Discussion Although AHA is mild, intracranial bleeding is a life-threatening condition. We also should pay attention to the presence of AHA patients when we extract teeth.

Acquired hemophilia A

“…6 Bleeding is often severe and life threatening with a high mortality rate. 7 AHA should be suspected in any bleeding patient with elevated aPTT and a normal prothrombin time. The first step in a suspected case after excluding the use or presence of heparin is to perform a mixing study 8 (Figure 1).…”

Recognizing acquired hemophilia A as a cause of subdural hemorrhage and use of thromboelastography to guide management in neurocritical care unit

“…Approximately 50% of AHA cases are idiopathic with all other cases associated with autoimmune diseases such as systemic lupus erythematosus, hematologic malignancy, use of certain medications including penicillin and sulfa antibiotics, and acute hepatitis B and C infections [2]. Intracranial hemorrhage in as-sociation with AHA is an even rarer occurrence (1-1.4% of AHA patients) [3]. Therefore, greater awareness and preparation is needed to manage acute intracranial bleed due to acquired factor VIII inhibitors.…”