Successful Perioperative Management of Severe Bleeding From Undiagnosed Acquired Factor VIII Inhibitors

ACQUIRED HEMOPHILIA A occurs as a result of development of inhibitory autoantibodies to factor VIII in the coagulation cascade. These antibodies result in impaired hemostasis and bleeding disorders of variable severities through varied mechanisms including impairment of binding of factor VIII to membrane phospholipids, factor IX, and/or von Willebrand factor. Common presentation includes mucocutaneous and soft tissue hemorrhage, although hemarthroses typically seen in severe congenital hemophilia A are rare. Most patients are diagnosed during the course of evaluation of bleeding symptoms, and for such patients requiring cardiac surgery, management has been described previously. The successful postoperative management of a case of acquired hemophilia A diagnosed perioperatively after cardiac surgery is reported here.