Management of Acquired Hemophilia A in Elderly Patients

Abstract

This report describes six elderly patients with acquired hemophilia A (AHA), including four individuals aged ≥90 years. Bleeding symptoms were subcutaneous or intramuscular hemorrhage ( n = 4 ), hematuria ( n = 1 ), and hemorrhagic shock after tooth extraction ( n = 1 ). Factor VIII (FVIII) activity ranged from <1.0% to 3.0%, and anti-FVIII inhibitor titers ranged from 8.8 to 240 BU/mL. Treatment was administered at the discretion of the responsible physician. Hemostatic agents applied in the six patients comprised rFVIIa (NovoSeven®) ( n = 4 ), APCC (Feiba®) ( n = 2 ), and fresh frozen plasma/plasma exchange ( n = 1 ). Agents employed for inhibitor eradication comprised prednisolone only ( n = 3 ), prednisolone with cyclophosphamide ( n = 1 ), prednisolone with cyclosporine ( n = 1 ), and prednisolone with rituximab ( n = 1 ). In five patients, management was successful, with complete response. Treatment failed in the patient with the highest inhibitor level (240 BU/mL) in whom treatment with APCC (Feiba®; 100 U/kg/dose, three doses) and prednisolone (0.5 mg/kg/day) was followed by several episodes of relapse. The present data demonstrate that AHA severity shows wide variation in elderly subjects, indicating the necessity of individualized management.