Acquired Hemophilia A: A rare, acquired coagulopathy in the postpartum setting

Abstract

Background Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity. Pregnancy-associated acquired hemophilia A (AHA) caused by autoantibodies against factor VIII can present with recurrent episodes of postpartum bleeding. Case(s) Case 1: 50-year-old P0112 with vaginal bleeding 22 days post-cesarean. She underwent dilation and curettage, hysterectomy, and interventional radiology (IR) embolization before AHA diagnosis. She was hospitalized 32 days and received 23 units of blood product. She remains without relapse of AHA after 5 years. Case 2: 48-year-old P1 with vaginal bleeding eight days post-cesarean. She underwent three surgeries and IR embolization before AHA diagnosis. She was hospitalized 18 days and received 39 units of blood product. Prednisone and cyclophosphamide were continued after discharge. Conclusions AHA is a rare cause of PPH. An isolated prolonged aPTT should prompt further workup in postpartum patients with refractory bleeding. Rapid recognition of AHA can prevent significant morbidity related to hemorrhage, massive transfusion, and multiple surgeries.