Diagnostic Challenges in a Patient with Acquired Hemophilia A: a Case Report from Rural Hospital

A Case Report

Abstract

Acquired Hemophilia A (AHA) is a rare autoimmune bleeding disorder caused by autoantibodies against factor VIII, typically affecting older adults without prior bleeding history. Its nonspecific presentation often leads to underdiagnosis, particularly in resource-limited settings. We report a 62-year-old woman presenting with spontaneous extensive bruising without trauma or anticoagulant use. Examination revealed multiple hematomas. Laboratory findings showed anemia (Hb 9.1 g/dL), normal platelet count and prothrombin time, and isolated prolonged APTT that failed to correct on mixing study, indicating an inhibitor. Factor VIII activity was markedly reduced (5%). Due to limited facilities, inhibitor titration could not be performed. A diagnosis of AHA was established, and the patient was treated with corticosteroids and azathioprine, resulting in clinical improvement. Diagnosis of AHA relies on recognizing isolated prolonged APTT uncorrected by mixing studies. In rural hospitals, limited access to specialized assays poses challenges, making early clinical suspicion essential. Management includes bleeding control and inhibitor eradication using immunosuppressive therapy. AHA should be suspected in patients with unexplained bleeding and isolated prolonged APTT. This report highlights a pragmatic diagnostic approach to AHA in resource-limited settings where confirmatory assays are unavailable.