An Interesting Case of Acquired Hemophilia A in an Elderly Patient Presenting with Hematuria

Mehta, Parth; Reddivari, Anil Kumar Reddy

doi:10.7759/cureus.6540

Cited by 18 publications

(35 citation statements)

References 16 publications

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“…34,35 All other showed normal aPTT, essentially excluding hemophilia from the etiology of the SMH. 38 In addition, other laboratory tests, including platelets, INR, fibrinogen, and the fibrinolysis marker D-dimer were found to be normal, thereby highly excluding DIC. 39 Outside of COVID-19, the incidence of SMH in patients on anticoagulants is 0.6%, with higher prevalence in the elderly.…”

Section: Discussionmentioning

confidence: 97%

Spontaneous Muscle Hematoma in Patients with COVID-19: A Systematic Literature Review with Description of an Additional Case Series

Abate

Casoria

Rendina

et al. 2021

Semin Thromb Hemost

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Coagulation abnormalities, thrombosis, and endothelial dysfunction have been described in COVID-19 patients. Spontaneous muscle hematoma (SMH) is a rare complication in COVID-19. The aims of this study are to: (1) perform a systematic review of the literature to better define the clinical SMH characteristics, (2) describe the prevalence and the clinical characteristics of SMH in COVID-19 patients referring to a Department of Internal Medicine (IM) (Federico II University of Naples), a Department of Sub-Intensive Care Medicine (SIM) (Ospedale Del Mare), and a Department of Intensive Care Unit (ICU) (Federico II University). The systematic review was performed according to PRISMA criteria. The local prevalence of SMH in COVID-19 was evaluated retrospectively. The medical records of all COVID-19 patients referring to IM and ICU from March 11th, 2020, to February 28th, 2021 were examined for SMH occurrence. In our retrospective analysis, we describe 10 cases of COVID-19 patients with SMH not previously reported in literature, with a prevalence of 2.1%. The literature review, inclusive of our case series, describes a total of 50 SMHs in COVID-19 patients (57.4% males; mean age 68.8 ± 10.0 years). The SMH sites were ileo-psoas, vastus intermedius, gluteus, sternocleidomastoid, and pectoralis major muscles. Males developed SMH earlier than females (9.5 ± 7.8 vs. 17.1 ± 9.7 days). Ileo-psoas hematoma was more frequent in males (69.2 vs. 30.8%), while pectoralis major hematoma occurred only in females. The in-hospital mortality rate of SMH in COVID-19 patients was 32.4%. SMH is a rare but severe complication in COVID-19 hospitalized patients, associated with high mortality. A gender difference seems to be present in the clinical presentation of the disorder.

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Section: Discussionmentioning

confidence: 97%

Spontaneous Muscle Hematoma in Patients with COVID-19: A Systematic Literature Review with Description of an Additional Case Series

Abate

Casoria

Rendina

et al. 2021

Semin Thromb Hemost

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“…Hemophilia A and B are X-linked genetic diseases caused by mutation in the factor VIII and factor IX genes leading to coagulation disorders [2], the clinical form of which is identical [14]. They usually present as bleeding after minor insignificant trauma or as a spontaneous hemorrhage [15]. Based on the plasma levels of factors hemophilia patient may develop mild, moderate and severe form of the disease.…”

Section: Discussionmentioning

confidence: 99%

“…Gum bleeding age [14,22]. Moreover, spontaneous bleeding is uncommon in mild cases, and recurrent joint bleed may be present in up to 25% of moderate cases [22] leading to delayed suspicion.…”

Section: Mucosal Bleedingmentioning

confidence: 99%

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Clinical profile and demographic characteristics of moderate and severe hemophilia patients in a tertiary care hospital of Bangladesh

Islam¹,

Biswas

Nazneen

et al. 2022

Orphanet J Rare Dis

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Background Hemophilia is one of the commonest inherited bleeding disorders which may lead to chronic bleeding tendencies and life-long disabilities if not properly managed. Knowing the pattern of the disease aids in the prevention of disability and improvement of quality of life in hemophilia. However, there is a dearth of literature on the issue in Bangladesh. So, this study was designed to explore the frequency and site of spontaneous bleeding in moderate and severe hemophilia patients visiting in a tertiary level hospital. Methods This descriptive cross-sectional study was conducted at the department of Hematology and Bone Marrow Transplantation (BMT) Center in Dhaka Medical College Hospital, Dhaka between February 2020 and August 2020. A total of 44 diagnosed cases of moderate to severe hemophilia were included in the study according to inclusion criteria. A detailed inquiry of history, thorough physical examination and relevant investigations were done and were recorded in case-record form. Informed written consent was taken from patients or their guardians where appropriate. All procedures were done according to Declaration of Helsinki. After entry and checking, data was analysed using SPSS version 26. Results Out of 44 participants, 25 (56.8%) and 19 (43.2%) had moderate and severe hemophilia. Mean age of the study population was 21.31 (± 9.78) years with the majority aged between 11 and 20 years (45.5%). All sociodemographic features were similar across severity. Hemophilia A and B was found in 90.9% and 9.1%, respectively. However, all type B patients severe hemophilia making it statistically significantly different from type A (p = 0.029). The median age of first bleeding was 3.5 years and median age of first diagnosis was 5 years. Nevertheless, approximately 67.4% patients were diagnosed as a case of hemophilia at the time of their first diagnosis. The median spontaneous bleedings episodes among all patients was 32 (range: 0–97) which did not different significantly between severe and moderate patients. The most common affected (target) joint was knee joint (88.6%) followed by elbow joint (64%) among all patients. The knee joint was more commonly involved in severe than moderate disease. Conclusion This study observed the variations in pattern and frequency of spontaneous bleeding in patients with hemophilia. Severe disease was more frequent in hemophilia B than A and knee joint was the most frequent site of bleeding. However, further extensive studies are recommended.

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“…Hemophilia is a group of rare bleeding disorders, recessive genetic diseases linked to the X chromosome (1,2). Due to the lack of coagulation factors from the intrinsic pathway, patients present with prolonged bleeding after injury, easy bruising, or even spontaneous bleeding (3). These symptoms pose a great risk of permanent damage if the bleeding occurs internally, inside the joints, intramuscularly, or intracranially (4).…”

Section: Introductionmentioning

confidence: 99%

Mobile Health Technology for the Personalized Therapy of Hemophilia

et al. 2021

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The management of patients with hemophilia has evolved significantly since the first treatment attempts were made in the late 1930s. Since then, each new step in the treatment of patients with hemophilia has brought important advancements, as well as its unique set of challenges. Today, a patient-centered, individualized comprehensive approach is the new paradigm, moving away from the traditional “one size-fits-all” approach, to provide the best possible care for each patient with a bleeding disorder. As part of this complex task, mobile health applications might have the capacity to play an important role in reaching that goal. However, the use of new electronic technologies as part of a comprehensive treatment approach for patients with hemophilia simultaneously presents a new set of challenges that needs consideration. In the first section, currently available treatment of hemophilia patients will be revised, while in the second part the role of IT software in the treatment monitoring of hemophilia patients will be discussed.

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An Interesting Case of Acquired Hemophilia A in an Elderly Patient Presenting with Hematuria

Cited by 18 publications

References 16 publications

Spontaneous Muscle Hematoma in Patients with COVID-19: A Systematic Literature Review with Description of an Additional Case Series

Spontaneous Muscle Hematoma in Patients with COVID-19: A Systematic Literature Review with Description of an Additional Case Series

Clinical profile and demographic characteristics of moderate and severe hemophilia patients in a tertiary care hospital of Bangladesh

Mobile Health Technology for the Personalized Therapy of Hemophilia

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