An 80-year-old man was treated at our hospital for
chronic kidney disease,
diabetes mellitus and
hypertension. He presented a
bleeding tendency over the past several weeks. When he was admitted to our hospital with a consciousness disturbance, he had irregular 10-20 cm patches of subcutaneous
bleeding. Laboratory findings showed prolonged activated partial thromboplastin time (APTT) but normal platelet count and prothrombin time. The administration of fresh frozen plasma did not control the
bleeding tendency and the result of APTT cross-mixing test suggested the presence of
factor VIII inhibitor. The diagnosis of acquired
hemophilia A was made by a marked decrease in
factor VIII activity levels (<1 %) and a high titer of
factor VIII inhibitor (11 Bethesda units). To remove the
factor VIII inhibitor and suppress its production,
plasma exchange was performed and
methylprednisolone was administered. Thereafter, the
bleeding tendency could be controlled with APTT measurement normalization.
Plasma exchange does not have a first priority in the treatment but our case findings suggested that
plasma exchange is an effective method for eliminating
factor VIII inhibitor and alleviating acquired
hemophilia A severity.