Acquired hemophilia A in a female with minimal change disease and hypothyroidism: a rare case report

Introduction and importance: Acquired hemophilia A (AHA) is rare and potentially lethal autoimmune disease marked by IgG antibodies against clotting factor VIII. Diagnosis is confirmed by activated partial thromboplastin time (aPTT) and lower factor VIII levels, while management requires immunosuppression and bleeding control. Case presentation: A 38-years-old female without past personal and family history, presented with abdominal pain, dizziness, and bilateral rectus sheath hematoma. Laboratory findings showed elevated aPTT and low factor VIII, suggesting acquired hemophilia. She was managed with two pints of packed red blood cells, alternate day prothrombin complex concentrate and immunosuppressive agents. Follow-up showed resolution of symptoms and normalization of aPTT. Case discussion: A patient, born from non-consanguineous marriage, without any prior history of bleeding, was thoroughly evaluated for coagulopathy. Reports revealed isolated rise of aPTT levels, low factor VIII levels with presence of factor VIII inhibitors on the Bethesda assay. This brought us to the diagnosis of acquired hemophilia. Conclusion: The rarity and complexity of AHA makes diagnosis difficult. However, early diagnosis and prompt but appropriate treatment significantly enhances patient’s prognosis.