Perioperative management of acquired hemophilia a: a case report and review of literature

Yashar Ilkhchoui; Eugene Koshkin; Jimmy J Windsor; Timothy R Petersen; Matthew Charles; Jeffery D Pack

doi:10.5812/aapm.11906

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Perioperative management of acquired hemophilia a: a case report and review of literature

Journal article

Open access

Perioperative management of acquired hemophilia a: a case report and review of literature

Yashar Ilkhchoui, Eugene Koshkin, Jimmy J Windsor, Timothy R Petersen, Matthew Charles and Jeffery D Pack

Anesthesiology and pain medicine, Vol.4(1), p.e11906

02/2014

DOI: 10.5812/aapm.11906

PMCID: PMC3961036

PMID: 24660144

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Abstract

Acquired hemophilia A is a rare bleeding disorder with a high mortality rate. Diagnosis and treatment of this disorder can be very challenging to anesthesiologists because of lack of a personal or familial abnormal bleeding history. We report a 60-year-old woman who presented to the operating room for an urgent fasciotomy. She was initially diagnosed to have compartment syndrome of her left upper extremity secondary to an expanding hematoma after multiple unsuccessful venipuncture attempts. After surgical intervention, she developed recurrent intramuscular hematomas, became severely anemic, and required surgical re-exploration and multiple blood product transfusions. Ultimately, she was found to have an elevated activated partial thromboplastin time (aPTT), very low FVIII activity, and high FVIII inhibitor titers consistent with the diagnosis of acquired hemophilia A. Treatment strategies in acquired hemophilia are based on two major objectives. During the acute stage, effective control of bleeding is critical. The ultimate therapeutic goal during the subacute phase is the elimination of the inhibitors targeting factor VIII. Here, we present this case and will review current literature regarding therapeutic approaches to this rare condition in the operating room setting and postoperative course.

Perioperative Care

Factor Eight Inhibitor Bypassing Activity

Immunosuppressive Agents

Details

Title: Subtitle: Perioperative management of acquired hemophilia a: a case report and review of literature
Creators: Yashar Ilkhchoui - Department of Anesthesiology and Critical Care Medicine, School of Medicine, University of New Mexico, Albuquerque, USA
Eugene Koshkin - Department of Anesthesiology and Critical Care Medicine, School of Medicine, University of New Mexico, Albuquerque, USA
Jimmy J Windsor - Department of Anesthesiology and Critical Care Medicine, School of Medicine, University of New Mexico, Albuquerque, USA
Timothy R Petersen - Department of Anesthesiology and Critical Care Medicine, School of Medicine, University of New Mexico, Albuquerque, USA
Matthew Charles - Department of Anesthesiology and Critical Care Medicine, School of Medicine, University of New Mexico, Albuquerque, USA
Jeffery D Pack - Department of Anesthesiology and Critical Care Medicine, School of Medicine, University of New Mexico, Albuquerque, USA
Resource Type: Journal article
Publication Details: Anesthesiology and pain medicine, Vol.4(1), p.e11906
DOI: 10.5812/aapm.11906
PMID: 24660144
PMCID: PMC3961036
NLM abbreviation: Anesth Pain Med
ISSN: 2228-7523
eISSN: 2228-7531
Publisher: Netherlands
Language: English
Date published: 02/2014
Academic Unit: Anesthesia
Record Identifier: 9984007169502771

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