Acquired Hemophilia in a Patient with Rheumatoid Arthritis

Abstract

Acquired haemophilia is a rare, life-threatening autoimmune disorder caused by inhibitory autoantibodies directed against various plasma clotting factors. In clinical practice, the most frequently observed are inhibitors of factor VIII - acquired haemophilia A. In about 50% of cases the disease develops in previously healthy subjects, in 35-40% it is secondary to autoimmune disorders, drug reactions or malignancy and in 10-15% it is associated with pregnancy and puerperium. Treatment of acquired haemophilia includes effective bleeding control and elimination of the inhibitor - the ultimate cure for the disease. Authors present a case of a 55-year-old patient with rheumatoid arthritis and acquired haemophilia A (Fig. 1, 2). The manifestations of haemorrhagic diathesis subsided after intravenous application of recombinant activated factor VII, prednisone and cyclophosphamide. The purpose of this report is to increase awareness of the possibility of acquired haemophilia as the reason of bleeding (especially subcutaneous) in patients with rheumatic diseases. Early diagnosis and proper treatment are critical for the disease outcome.