Refractory Obstetric Hemorrhage As the Initial Presentation of Acquired Hemophilia: A Case Report on the Diagnostic Limitations of Viscoelastic Testing.
4 affiliations
- 1Critical Care Medicine, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, MEX.
- 2Internal Medicine, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, MEX.
- 3Intensive Care Medicine, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, MEX.
- 4Hematology, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, MEX.
Abstract
Acquired hemophilia A is a rare autoimmune bleeding disorder caused by the development of autoantibodies against coagulation factor VIII. It is frequently associated with the postpartum period and may present as severe and persistent bleeding in patients without a prior history of coagulopathy, often leading to diagnostic delay. We report the case of a 26-year-old woman in the postpartum period following cesarean section for severe preeclampsia, who developed refractory hemorrhage despite multiple surgical interventions, including exploratory laparotomies, hematoma drainage, and abdominal packing. Laboratory evaluation revealed an isolated prolongation of activated partial thromboplastin time. Mixing studies showed incomplete correction, raising suspicion of a circulating inhibitor. Further testing confirmed severely reduced factor VIII activity and the presence of a factor VIII inhibitor. Serial thromboelastography demonstrated profound hypocoagulability with impaired thrombin generation and episodes of hyperfibrinolysis. The patient was treated with bypassing agents and combined immunosuppressive therapy, resulting in progressive reduction of inhibitor levels and recovery of factor VIII activity, ultimately achieving complete hematologic remission. This case highlights the diagnostic challenges of acquired hemophilia A in the postpartum setting and emphasizes the importance of early recognition of isolated coagulation abnormalities. Prompt diagnosis and a coordinated multidisciplinary approach are essential for effective bleeding control and inhibitor eradication in critically ill patients.
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BibTeX
@article{merlos2026refractory,
title = {{Refractory Obstetric Hemorrhage As the Initial Presentation of Acquired Hemophilia: A Case Report on the Diagnostic Limitations of Viscoelastic Testing.}},
author = {Maria Alaciel Galvan Merlos and Maria Dioselina Ruiz Barrera and Cristina Elizabeth Madera Maldonado and Liliana Ponce Baños and Jorge Omar Castro Meza and Lourdes Bautista Martinez and Leticia Guerrero Navarrete},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.117012},
url = {https://europepmc.org/article/MED/42948504},
note = {CC BY},
}
RIS
TY - JOUR
TI - Refractory Obstetric Hemorrhage As the Initial Presentation of Acquired Hemophilia: A Case Report on the Diagnostic Limitations of Viscoelastic Testing.
AU - Maria Alaciel Galvan Merlos
AU - Maria Dioselina Ruiz Barrera
AU - Cristina Elizabeth Madera Maldonado
AU - Liliana Ponce Baños
AU - Jorge Omar Castro Meza
AU - Lourdes Bautista Martinez
AU - Leticia Guerrero Navarrete
PY - 2026
DA - 2026/09/27
JO - Cureus
DO - 10.7759/cureus.117012
UR - https://europepmc.org/article/MED/42948504
AB - Acquired hemophilia A is a rare autoimmune bleeding disorder caused by the development of autoantibodies against coagulation factor VIII. It is frequently associated with the postpartum period and may present as severe and persistent bleeding in patients without a prior history of coagulopathy, often leading to diagnostic delay. We report the case of a 26-year-old woman in the postpartum period following cesarean section for severe preeclampsia, who developed refractory hemorrhage despite multiple surgical interventions, including exploratory laparotomies, hematoma drainage, and abdominal packing. Laboratory evaluation revealed an isolated prolongation of activated partial thromboplastin time. Mixing studies showed incomplete correction, raising suspicion of a circulating inhibitor. Further testing confirmed severely reduced factor VIII activity and the presence of a factor VIII inhibitor. Serial thromboelastography demonstrated profound hypocoagulability with impaired thrombin generation and episodes of hyperfibrinolysis. The patient was treated with bypassing agents and combined immunosuppressive therapy, resulting in progressive reduction of inhibitor levels and recovery of factor VIII activity, ultimately achieving complete hematologic remission. This case highlights the diagnostic challenges of acquired hemophilia A in the postpartum setting and emphasizes the importance of early recognition of isolated coagulation abnormalities. Prompt diagnosis and a coordinated multidisciplinary approach are essential for effective bleeding control and inhibitor eradication in critically ill patients.
SN - 2168-8184
ER -