Rheumatologists Should Consider Acquired Hemophilia as a Cause of Hemarthrosis

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Rheumatologists Should Consider Acquired Hemophilia as a Cause of

Hemarthrosis

Joint Bone Spine. 2003;70:521-523. 12/31/2003

http://www.docguide.com/

A DGReview of : " Hemarthrosis in acquired hemophilia. Two case-reports "

Joint Bone Spine

Acquired haemophilia is rare but should be considered as a cause of

haemarthrosis, especially since early diagnosis improves outcome,

concludes a report describing 2 case patients.

Acquired haemophilia is uncommon, with an incidence of 1 to 4 cases per

million per year. The diagnosis should be considered in patients with

sudden onset of a bleeding diathesis and no personal or family history

of coagulopathy, suggest Wendling, MD, and Marie-Anne Bertrand,

MD, from the Minjoz Teaching Hospital, Besancon, France.

Haemarthrosis, or diffusion of blood into the joints, in an adult can be

related to a variety of causes, including acquired haemophilia. To

illustrate this issue, the authors describe 2 cases.

With the first case, the authors describe a woman who experienced onset

of juvenile idiopathic arthritis at 8 years of age. She gave birth to

her first child when she was 28-years-old. Three months after delivery,

she developed vaginal bleeding and recurrent haemarthrosis, which led to

a diagnosis of acquired haemophilia, as indicated by isolated APTT

prolongation, 1% VIIIc activity, and 58 U of anti-factor VIII antibody.

The woman was treated with glucocorticoid therapy, prothrombin complex,

and intravenous immunoglobulins and fully recovered within a year.

In the second case, an 84-year-old woman developed spontaneous recurrent

haemarthrosis with haematomas attributed to idiopathic acquired

haemophilia. She was treated with prothrombin complex, factor VIII

concentrates, and intravenous immunoglobulins, followed by

cyclophosphamide and glucocorticoid therapy.

This woman also recovered within a year.

The researchers note that acquired haemophilia can result from

rheumatoid arthritis, lupus, and Sjogren's syndrome. Pregnancy is

another classic cause, and can occur during the third trimester or the

first year following delivery. Malignancies and drug-induced

immunoallergic reactions can also cause acquired haemophilia.

" Rheumatologists should be aware that acquired hemophilia can cause

hemarthrosis. Although this condition is rare, an early diagnosis is

essential to prevent life-threatening bleeding complications, " they

conclude.