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A patient with spontaneous acquired circulating inhibitor to factor VIII and factor IX is reported. This 80 year old previously well black female developed spontaneous bleeding in the right forearm after ingestion of 650 mg of aspirin the day of the bleed. Acquired anticoagulants were identified by factor assay. Factor VIII and factor IX activities were 1.7% and 60% of normal. Dilution analysis revealed a factor VIII antibody titer of 1: 100. Diagnostic evaluations for collagen vascular disease, rheumatoid arthritis, inflammatory bowel disease, and paraproteinemias were negative. Treatment was instituted on day 1 with prednisone (80 mg per day) and azothiaprine (150 mg per day). Hemorrhage ceased within two days of therapy. After one week of therapy, factor VIII level had risen to 8%. On day 16 azothiaprine therapy was discontinued and prednisone was tapered. There was no further spontaneous bleeding. Aspirin therapy may result in clinically significant hemorrhage in otherwise asymptomatic patients with spontaneous factor VIII inhibitors.

Deleterious Effect Of Aspirin In The Asymptomatic Patient With Spontaneous Factor VIII Inhibitor