Haemophilia in Cam: Allopathic Perspective

Acquired hemophilia A (AHA) is a rare acquired bleeding disorder. It is caused by factor VIII autoantibodies which neutralize factor VIII. Acquired hemophilia differs from congenital hemophilia A where there are alloantibodies to factor VIII products after repeated exposure to plasma-derived or recombinant factor VIII products. Nearly 50% of cases are idiopathic. The hallmark of AHA is mucocutaneous bleeding; ecchymosis, melena, hematoma, and hematuria. Diagnosis is based on isolated prolonged aPTT, normal PT, absence of lupus anticoagulant, and a mixing test for the presence of inhibitors, finding neutralizing antibodies against VIII lead to a diagnosis. Our discussion revolves around a young male with a history of complementary and alternative medicine (CAM) with no history of anticoagulant use presenting with hematuria, bruises, and hematoma. His laboratory investigations were significant for isolated prolongation of aPTT and subsequent testing revealed low factor VIII levels with factor VIII inhibitors which led to the diagnosis of HA. He was managed with medications and withdrawal of the offending drug resulted in the normalization of aPTT. We believe CAM might be the culprit since withdrawing that medication relieved all symptoms and there is no recurrence. Further research is needed to confirm the association between complementary alternative medicine and AHA.

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Author: Nitish Nichenametla