Gastric ulcer bleeding in acquired hemophilia A patient and persistent inhibitor successfully treated with endoscopic methods of hemostasis

Abstract

ABSTRACT: Acquired hemophilia A (AHA) is extremely rare, life-threatening bleeding disorder caused by sudden development of autoantibodies against coagulation factor VIII. Invasive procedures in AHA patients with persistent inhibitor, resistant to eradication therapies, pose an extreme threat of life due to uncontrolled bleeding poorly respond to surgical methods of hemostasis and bypassing agents. We report a case of idiopathic AHA 71-year-old patient with persistent high-titer inhibitor (104 BU) resistant to immunosuppressive treatment and immune tolerance induction. The patient was admitted with severe bleeding gastric ulcer complicated by gastric mucosal lacerations (Mallory-Weiss tears). Repeated endoscopic treatment with injection therapy and argon plasma coagulation were applied resulting in bleeding arrest. As bypassing agent recombinant active factor VII (rFVIIa) was applied with an average dose of 91.26 µg/kg (administering cumulatively of 134 doses during 14 days) and the total dose of 855.82 mg. In conclusion, gastric ulcer bleeding in AHA patient with persistent inhibitor can be successfully arrested with the use of endoscopic hemostasis methods and proper doses of rFVIIa.