Case of acquired hemophilia with factor VIII inhibitor in a mother and newborn

Abstract

We report a mother and newborn in the puerperium with hemorrhage secondary to factor VIII inhibitor. A 31-year-old gravida 1 para 1 delivered at a local clinic with a massive postpartum hemorrhage. The activated partial thromboplastin time was prolonged and factor VIII inhibitor was detected. The persistent hemorrhage improved following treatment, including transfusion, steroid therapy, and bypass therapy with factor VII formulations. After hysteroscopic removal of the retained placenta, the hemorrhage decreased. The newborn developed significant swelling of the hands after routine blood sampling and factor VIII inhibitor was detected. The inhibitor disappeared without any special treatment in the 5th month postpartum in the mother and the 4th month postpartum in the newborn. Factor VIII inhibitor may be transferred via the placenta from the mother to the fetus. Therefore, the newborn should also be carefully observed in a case of massive hemorrhage after delivery.

Acquired haemophilia A in the postpartum and risk of relapse in subsequent pregnancies: A systematic literature review

“…These cases are of particular importance as timely diagnosis allows for prevention of catastrophic maternal bleeding during delivery as well as increased surveillance of the newborn. In the three cases where the baby was symptomatic, the mothers developed symptoms simultaneously, 19,40,41 an observation providing further argument for a transplacental transfer of auto‐antibodies. These can be of different immunoglobulin subclasses, the most prevalent are from the IgG class, 61 known for transplacental transfer and thus potentially inhibiting the foetus's FVIII.…”

Acquired factor XI deficiency and therapeutic plasma exchange

“…5 Indeed, maternally acquired FVIII inhibitors have been described that circulate in the neonate for up to four months post-delivery. 6 While such maternally derived inhibitors are often clinically asymptomatic, 6 they are associated with low neonatal factor levels 6,7 and there are cases of such inhibitors being associated with intraventricular hemorrhage. 7 It has been recommended that these pregnancies be managed as if the fetus is potentially functionally hemophilic.…”

Unexpected Postpartum Hemorrhage Due to an Acquired Factor VIII Inhibitor

“…It is important to note that, while sporadic, several case reports have described transplacental transfer of maternal FVIII autoantibodies to the fetus that can result in clinically significant infant bleeding and morbidity. 11,15,24,[51][52][53][54][55] The mechanism most likely involves a specialized transplacental immunoglobulin transport process normally active during late-stage pregnancy to provide maternal antibodies for early newborn humoral immunity. 56,57 The incidence of acquired neonatal postpartum acquired hemophilia A is unknown, although morbidity, if it occurs, can range from mild epistaxis and ecchymoses to life-threatening intracranial hemorrhage.…”

“…11,15,24,[51][52][53] Neonatal postpartum acquired hemophilia A also has a benign course with rapid clearance and elimination of maternal FVIII inhibitors once bleeding is controlled with appropriate hemostatic medical intervention. 11,15,54,55 Management of the Patient with a Confirmed Acquired FVIII Inhibitor Diagnosis…”