Acquired hemophilia A a case report /
Jemuel O. Chavez.
- Fairview, Quezon City Department of Medicine, FEU-NRMF, 2016
- photos; (in folder)
Includes bibliographical references.
ABSTRACT: Case Report: this is a case of a 27 year-old female, Filipino non hypertensive, non diabetic, non smoker, occasional alcohol beverage drinker, without a history of trauma, illicit drug use, easy bruising nor hematologic disorders, who presented with tenderness on the upper and lower extremities, described as warm to touch, with ecchymosers on the forearm, midarm, leg and food measuring 5x6cm - 7x8cm, along with grade II bipedal edema. Laboratories requested were complete blood count which revealed leukocytosis with predominance of segmenters; bleeding parameters which showed decreased bleeding time to 1 minute and 30 seconds, normal clotting time, normal prothrombin time, and a prolonged aPTT. Serum sodium and serum potassium and creatinine were within normal ranges. Additional laboratories were requested such as ANA of 0.1 (negative), ASO of 488 lu/ml (2.44x elevated), total CPK of 1,195 U/L (6.22x elevated), CPK-MB of 21 U/L (normal), CK-MM of 1,174 (7.02x elevated). Patient was initially managed as Post streptococcus syndrome probably streptococcus myositis and was started on Clindamycin 300mg/tab q6. Amoxicillin was shifted to PEN G 1M units q6 TSIVP, and Tramadol 50mg/cap, 1 capsule q8 was given for pain. Further laboratory up were done such as kaolin clotting time which had a result of 210 seconds (2.1x prolonged) and control of 79 seconds. Peripheral blood smear showed red normocytic, normochromic RBCs with few micorcytic red cells, increased WBCs, predominantly segmenters. The rest are few lymphocytes and monocytes. Platelets were increased. ESR (5.1 x elevated) and CRP (3.66 x elevated). Also, anti- cardiolipin, Beta 2 GPI, factor 7 and factor 8 inhibitor Bethesda assay were requested, all of which had negative results. Anticardiolipin antibody IgG was 2.49 (negative), anti-cardiolipin antibody IgM was 14.57 (negative), Factor VII assay was 1.0% of the norm (70-15% of the normal reference range, Control of 104.5%) and Factor VII inhibitor Bethesda assay result was 15.88 (normal value is 0). Patient was now managed as a case of Aquired Hemophilia A.