Hemophilia A - acquired during coronary artery bypass grafting

Abstract

We report a challenging case of a rare cause of post operative bleeding that occurred after the coronary artery by-pass graft procedure. We believe that acquired hemophilia A was the main culprit. Patient post CABG developed nonsurgical bleeding with new isolated PTT prolongation. Bleeding was resistant to conventional therapy. Mixing studies didn't correct PTT, thus we ruled out factor deficiencies. Heparin effect was excluded by normal factor X levels. Patient received factor VIII inhibitor bypass therapy after which corrected PTT and stopped bleeding. The triad of acquired coagulopathy, noncorrectable PTT, and exclusion of heparin effect, make acquired hemophilia A the most likely diagnosis.

Keywords

• hemophilia a
• cabg
• factor viii inhibitor
• ptt
• heparin