A case of acquired hemophilia diagnosed incidentally on postoperative bleeding after tooth extraction

Abstract

Acquired hemophilia is a rare disease, diagnosed in individuals without any prior bleeding history. The incidence rate is reported to be 1 to 4 patients per million population. We report a case of acquired hemophilia diagnosed incidentally on postoperative bleeding after tooth extraction. A 71-year-old man was referred to our department because of postoperative bleeding after extraction of the lower anterior teeth. The patient had no previous episodes of bleeding tendency. Initial laboratory evaluation revealed a prolonged activated partial thromboplastin time (APTT) and decreased coagulant activity of factor VIII . Further examination revealed the presence of factor VIII inhibitors at the value of 3 Bethesda units. In our patient, the use of activated factor VII concentrates, effective for severe bleeding tendency in patients with acquired factor VII inhibitors, was unnecessary. He successfully responded to treatment with factor VIII concentrates and corticosteroids to control hemorrhage and inhibit the formation of autoantibodies against factor VIII (factor VIII inhibitors).

Exsanguinating bleeding following tooth extraction in a 12-year-old girl

“…Similar bleeding episodes have been well known in cases of CHA or von Willebrand disease. However, only five such AHA cases can be found in the literature [4][5][6][7] including one paediatric case of this report ( Table 1). All cases had a good outcome.…”