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Acquired hemophilia A manifesting as plasma transfusion‐uncontrolled severe bleeding 2 weeks after chorioamnionitis‐induced abortion
Author(s) -
Matsuoka Ayumi,
Sasaki Hiromasa,
Sugimori Chiharu,
Hirabuki Shinya,
Hoshiba Tsutomu,
Fujiwara Hiroshi
Publication year - 2017
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.13270
Subject(s) - medicine , partial thromboplastin time , fresh frozen plasma , prothrombin time , chorioamnionitis , surgery , recombinant factor viia , coagulation , pregnancy , anesthesia , obstetrics , fetus , platelet , genetics , biology
Acquired hemophilia A (AHA) is a serious and rare complication of pregnancy, caused by autoantibodies to coagulation factor VIII after delivery. We here report the case of a 36‐year‐old primigravida woman who developed AHA following chorioamnionitis‐caused miscarriage in the second trimester. Thirteen days after abortion, sudden, massive vaginal bleeding occurred with marked prolongation of activated partial thromboplastin time (APTT) in the absence of other abnormal coagulation data. Sequential transfusion of fresh frozen plasma did not achieve normalization of APTT. Further examination confirmed reduction of coagulation factor VIII and the presence of its inhibitor, leading to the final diagnosis of AHA. The patient was effectively treated with bypassing agents (activated prothrombin complex concentrate and recombinant activated factor VII) and immunosuppressive therapy. Fifteen months after remission, the patient became pregnant and successfully achieved term delivery with no signs of recurrence. This case illustrates that AHA should be considered in the occurrence of plasma transfusion‐uncontrolled severe bleeding after delivery.