Postoperative Management of Acquired Hemophilia A in Two Children and Literature Review

Abstract Background To report the clinical manifestations, diagnosis, and treatment of two pediatric cases of trauma/surgery-associated acquired hemophilia A (AHA) to improve the awareness of the postoperative management of pediatric AHA. Methods The clinical manifestations, laboratory test results, diagnosis, treatment processes, and therapeutic efficacy of two pediatric AHA patients admitted to our hospital between February 1, 2025, and December 1, 2025, were retrospectively analyzed, along with a literature review. Results Two cases of pediatric AHA both developed severe bleeding after surgery. One case was a 7-year-old girl who suffered from massive intra-abdominal hemorrhage complicated by gastrointestinal bleeding following surgery for a choledochal cyst. After a second exploratory laparotomy for hemostasis and hematoma evacuation, she developed severe complications including higher FVIII inhibitor levels、biliary fistula and peritonitis. She was eventually cured through conservative treatment. The other case was a 13-year-old girl who presented with necrotizing fasciitis caused by a thigh muscle hematoma. She underwent an incision and decompression along with the debridement of necrotic tissue, but the surgical wound continued to ooze blood postoperatively. After changing the hemostasis plan, the bleeding stopped. Both cases demonstrated a good prognosis without any sequelae during follow-up. Conclusions Clinical bleeding in trauma- or surgery-associated AHA is severe and unresponsive to conventional hemostatic methods, easily leading to life-threatening hemorrhage. Timely multi-disciplinary collaborative diagnosis and treatment(MDT), early identification and diagnosis of AHA, and standardized treatment are of great significance in improving the cure rate of the disease and saving lives.