Acquired Hemophilia A Associated with NSAID: A Case Report

Diane Lukito Setiawan, Yetti Hernaningsih


Acquired hemophilia A (AHA) is a blood clotting disorder caused by the presence of autoantibodies (inhibitors) against factor VIII. The typical symptom of this disorder is bleeding under the skin and soft tissue (rarely in the joints), with no family or personal previous history of bleeding. This case reports is tended to build up awareness for better diagnosis and therapy. Woman, 39 years old, bruises on both forearms are intermittent for 2 months with a history of long term drug consumption for headache treatment. Hemostatic test showed the elongation of activated partial thromboplastin test (APTT) to 87.1 (normal 24.4-44.4 seconds) and the decreament of factor VIII (FVIII) activity to 5% (normal 60-150%). Provision of recombinant factor VIII lowered factor VIII activity to 2%. Factor VIII inhibitor titer was 21.12 BU and diagnosis AHA was made. Inhibitor eradication by methylprednisolone tablet 3x16mg which was given for 2 months, improved the APPT to 46.7 seconds and factor VIII activity to 36%. Acquired Hemophilia A should be suspected in an adult bleeding patient with history of taking a long time non-steroidal anti-inflammatory drugs (NSAIDs). This case is a rare case in Indonesia and therefore the procedure for diagnosis needs to be improved in order to avoid errors in delivering a therapy which can cause the decreament of factor VIII activity.


Acquired Haemophilia; NSAID; inhibitor; factor VIII


Flisinski M, Windyga J, Stefariska E, et al. Acquired hemophilia: a case report. Polskie Archiwum Medycyny Wewnetrznej. 2008;118(4).

Tirunagari S, Shaik D. Hemophilia & Acquired Hemophilia A. Webmed Central CLINICAL TRIALS 2013;4(3):WMC004048.

Stefanacci RG. Acquired inhibitors: A special case of bleeding in older adults. Curr Gerontol Geriatric Res. 2012;308109:5. doi:10.1155/2012/308109.

Shah G, Kandra A, Drelich D. Acquired hemophila A: A case report. Med Forum. 2011;11:7.

Freire M, Teodoro RB, Nogueira DA, et al. Acquired hemophilia associated with rheumatoid arthritis. Bras J Rheumatol. 2009;49(3):302-7.

Giangrande P. Acquired hemophilia. Revised edition. Treatment of hemophilia. World Fed Hemophilia. 2012:38.

Ma AD, Carrizosa D. Acquired factor VIII inhibitors: Pathophysiology and treatment. Am Soc Hematol. 2006:432-7.

Lee JJ, Chung IJ, Park MR, et al. Acquired hemophilia successfully treated with oral immunosuppressive therapy. Korean J Intern Med. 2000;15:2.

Collins P, Baudo F, Huth-Kuhne A, et al. Consensus recommendation for the diagnosis and treatment of acquired hemophilia A. BMC Res Notes. 2010;3:161.

Sakurai Y, Takeda T. Acquired hemophilia A: A frequently overlooked autoimmune hemorrhagic disorder. J Immunol Res. 2014;320674.

Tufano A, Coppola A, Guida A. Acquired haemophilia A in the elderly: Case reports. Curr Gerontol Geriatric Res. 2010;927503.

Pathirana UGP, Gunawardena N, Abeysinghe H, et al. Acquired hemophilia A associated with autoimmune thyroiditis: A case report. J Med Case Reports. 2014;8:469.

Orlova NA, Kovnin I, Vorobiev I. Blood clotting factor VIII: From evolution to therapy. Acta Naturae. 2013;5 (17):2013.

Tanaka TN, Sohda S, Someya K. Acquired haemophilia due to factor VIII inhibitors in ovarian hyperstimulation syndrome: Case report. Human Reproduction. 2003:18(3):506-8.

Murray NP, Moncada JC, Moran M. Duodenal tumor presenting as acquired hemophilia in an 88-year-old woman: A clinical case and review of literature. Case Reports in Gastrointestinal Medicine. 2012;203801.

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