Surgery-associated factor VIII inhibitors in patients without hemophilia

Joshi Alumkal, Lawrence Rice, Hyma Vempathy, John McCarthy, Shirley A. Riggs

Research output: Contribution to journalArticle

13 Scopus citations

Abstract

The acquisition of antibodies to factor VIII (ie, factor VIII protein) by patients without hemophilia is associated with conditions such as pregnancy, lymphoma, and autoimmune disorders. We present three patients who acquired factor VIII antibodies in the postoperative setting. Preoperatively, none gave a history of bleeding even with past surgeries and all had normal coagulation tests. Within days of surgery (bowel resection, cholecystectomy, coronary bypass), a bleeding diathesis emerged with prolonged partial thromboplastin time, decreased factor VIII levels, and demonstrable factor VIII antibodies. All patients required multiple blood transfusions and urgent re-exploration for hemostatic control. All were treated with high dose human factor VIII infusions, corticosteroids, and various forms of immunosuppression. We wish to raise awareness of surgery as a precipitating cause of acquired hemophilia, which is something to be considered with unusual postoperative bleeding. This syndrome is remarkable for its abrupt onset within days of surgery, dramatic bleeding, subsequent persistence, but potential reversal by immunosuppression.

Original languageEnglish (US)
Pages (from-to)350-352
Number of pages3
JournalAmerican Journal of the Medical Sciences
Volume318
Issue number5
DOIs
StatePublished - Jan 1 1999

Keywords

  • Acquired hemophilia
  • Circulating anticoagulants
  • Factor 8 inhibitors
  • Hemophilia
  • Surgical bleeding

ASJC Scopus subject areas

  • Medicine(all)

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