Unusual Initial Manifestation of Acquired Hemophilia A: A Normal Activated Partial Thromboplastin Time, Intramuscular Hematoma and Cerebral Hemorrhage

Tsuyama, Nobuaki; Ichiba, Toshihisa; Naito, Hiroshi

doi:10.2169/internalmedicine.55.7219

Cited by 4 publications

(7 citation statements)

References 8 publications

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“…A hemophilia case first found during adulthood is actually rare, and few reports fit this condition. According to Tsuyama et al, 18 aPTT was normal at the first blood sampling due to the low disease level (1 BU/mL). In such a condition, repeated aPTT tests and measurements of coagulation factors are required.…”

Section: Discussionmentioning

confidence: 96%

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An incidental latent adult hemophilia case found after a tonsillectomy

Saikawa

Tsunoda

Sata

et al. 2021

SAGE Open Medical Case Reports

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Severe bleeding after a tonsillectomy may cause airway obstruction and be life-threatening. We report post-tonsillectomy bleeding in a 32-year-old patient with hemophilia A, who had not been aware of his disease for more than 30 years. He underwent tonsillectomy for recurrent tonsillitis. He denied episodes of bleeding tendency. The preoperative workup was normal, including platelet count, prothrombin time, and activated partial thromboplastin time. The surgery itself was uneventful, but severe bleeding from the inferior pole of the tonsillar bed developed 7 days after surgery. Emergency hemostasis was performed under general anesthesia in the operating room. The patient then remembered several episodes of bleeding tendency. Coagulation tests revealed a mild lack of coagulation factor VIII to 35%, and a diagnosis of hemophilia A was made. Hemophilia might only be found after surgery and can cause life-threatening complications. However, latent hemophilia detected after a tonsillectomy in a 32-year-old adult is very rare. A careful history of bleeding tendency is important to achieve a diagnosis of coagulopathy, perform a safer surgery, and prevent postoperative complications.

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Section: Discussionmentioning

confidence: 96%

“…In patients with mild forms of this disease, the main cause of bleeding is significant trauma or surgery. 6 , 13 , 15 – 18 …”

Section: Discussionmentioning

confidence: 99%

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An incidental latent adult hemophilia case found after a tonsillectomy

Saikawa

Tsunoda

Sata

et al. 2021

SAGE Open Medical Case Reports

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“…Nevertheless, great caution is required since sometimes APTT in AH may be within normal limits. In 2016, Tsuyama described a case of a 73-year-old patient with intramuscular haematoma and cerebral haemorrhage whose APTT in the initial evaluation was normal [9]. Only repeated coagulation studies revealed an isolated prolongation of the APTT.…”

Section: Discussionmentioning

confidence: 99%

An epileptic seizure and haemorrhage into the ventricular system of the brain as the first manifestations of acquired haemophilia A – Case report

Sokołowska¹,

Kozińska²,

Szczepanek³

et al. 2021

Ann Agric Environ Med.

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“…The measured value should be carefully considered because various causes could prolong the APTT including the current status of the patient and the anticipated clinical course. [ 26 31 ]…”

Section: Discussionmentioning

confidence: 99%

Mild hemophilia a presaged by recurrent postoperative hemorrhagic complications in an elderly patient

Ono¹,

Sase²,

Takasuna³

et al. 2017

Surg Neurol Int

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Background:Mild hemophilia without spontaneous bleeding can remain undiagnosed for a lifetime. However, intracranial hemorrhage is one of the most serious complications for patients with hemophilia. In addition, hemorrhagic complications after emergency surgery tend to arise from coagulopathy.Case Description:An 80-year-old man was admitted with left hemiparesis and disturbed consciousness. He had no history of trauma, fever, or drug and alcohol intake. Computed tomography imaging upon admission disclosed a hemispheric subdural hematoma with a midline shift. No vascular abnormalities were identified as a source of the hemorrhage. The hematoma was removed on an emergency basis with external decompression. However, a large subcutaneous hematoma was again evident on the following day. Insufficient hemostatic maneuvers during surgery were considered the cause of this hemorrhagic complication. A second operation was performed to achieve hemostasis of the subcutaneous and muscle tissue. Thereafter, he was rehabilitated without treatment for hemophilia as he had no bleeding episodes. Cranioplasty proceeded using artificial bone at 40 days after the first operation. However, epidural hematoma developed again on postoperative day 1. His neurological status did not worsen so a repeat procedure was unnecessary. Close scrutiny uncovered a diagnosis of mild hemophilia A.Conclusions:Accurate diagnosis is important for the management of postoperative hemorrhagic complications caused by pathologies of the coagulation system. Sufficient hemostasis of hemorrhage from subcutaneous and muscle tissue is essential even during emergency surgery to avoid postoperative complications. A diagnosis of hemophilia should be considered in the face of prolonged activated partial thromboplastin time (APTT).

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Unusual Initial Manifestation of Acquired Hemophilia A: A Normal Activated Partial Thromboplastin Time, Intramuscular Hematoma and Cerebral Hemorrhage

Cited by 4 publications

References 8 publications

An incidental latent adult hemophilia case found after a tonsillectomy

An incidental latent adult hemophilia case found after a tonsillectomy

An epileptic seizure and haemorrhage into the ventricular system of the brain as the first manifestations of acquired haemophilia A – Case report

Mild hemophilia a presaged by recurrent postoperative hemorrhagic complications in an elderly patient

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