Management of Acquired Hemophilia in the Emergency Department 

Acquired hemophilia A is a rare but potentially life-threatening autoimmune bleeding disorder that results from the development of autoantibodies that are directed against, and interfere with, the activity of clotting Factor VIII. Inhibition of Factor VIII, which functions as a cofactor for Factor IXa in the enzymatic activation of Factor X, leads to a reduction in the generation of thrombin on the surface of activated platelets.

Patients who develop autoantibodies against Factor VIII may present with severe and sometimes catastrophic bleeding episodes, despite having no previous history of a bleeding diathesis. Spontaneous ecchymoses, retroperitoneal and cerebral hemorrhages, gross hematuria, muscle bleeding, and intractable epistaxis are common in the patients with acquired hemophilia. This pattern of bleeding is in contrast to patients with hemophilia A, which is more often characterized by bleeding into the joints or soft tissues. Retrospective studies of patients with acquired hemophilia have reported mortality rates between 8% and 22%. A recent 2-year study of all patients with acquired hemophilia A in the United Kingdom (n=172) found that bleeding was the cause of death in 9% of the patients.

A 54-Year-Old Woman With Rheumatoid Arthritis, Bruising, Swelling, and Pain

Description Barbara M, a 54-year-old white woman presents to the emergency department with complaints of fatigue, bruising, and increasing pain and swelling in the left posterior thigh, hip, and buttock. She denies any history of trauma, but she describes a tendency to easily bruise for the past 6 months. Take this course now

A 69-Year-Old Man With Prostate Cancer and Extensive Spontaneous Ecchymoses

Description Anthony S, a 69-year-old white man with prostate cancer who is planning to undergo prostatectomy, presents to the emergency department (ED) with extensive spontaneous ecchymoses covering large areas of both arms, chest, right flank, and right thigh. Take this course now