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VOLUME 17 , ISSUE 6 ( December, 2013 ) > List of Articles

LETTER TO EDITOR

Acquired hemophilia complicated by cardiorenal syndrome type 3

Sananta Kumar Dash, Rakesh Sharma, Devender Kumar Agrawal, Harsh Dua

Keywords : Acquired hemophilia, cardiorenal syndrome, factor VIII inhibitor, recombinant activated factor VII

Citation Information : Dash SK, Sharma R, Agrawal DK, Dua H. Acquired hemophilia complicated by cardiorenal syndrome type 3. Indian J Crit Care Med 2013; 17 (6):378-381.

DOI: 10.4103/0972-5229.123456

License: CC BY-ND 3.0

Published Online: 01-12-2013

Copyright Statement:  Copyright © 2013; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Development of autoantibodies against coagulation factor VIII (FVIII) leads to a rare condition defined as acquired hemophilia (AH). If not diagnosed and treated early, AH may be associated with high mortality and morbidity. A 65-year-old woman presented with history of macrohematuria, acute renal failure, cardiogenic shock, and acute respiratory failure. Blood investigation revealed azotemia, prolonged activated partial thromboplastin time (aPTT), coagulation FVIII level of <1%, and presence of FVIII inhibitor. Echocardiography showed global hypokinesia and ultrasonography and computed tomography (CT) revealed bilateral hydroureteronephrosis. The final diagnosis was acquired hemophilia A, complicated by acute obstructive renal failure and cardiorenal syndrome (CRS) type 3. Patient was managed with mechanical ventilation, heparin-free hemodialysis, negative fluid balance, recombinant activated factor VII, and prednisolone. Hematuria was relieved, renal function improved, and cardiac function showed improvement on repeat echocardiography. Patient was discharged on prednisolone with subsequent follow ups.


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  1. Shander A, Walsh CE, Cromwell C. Acquired hemophilia: A rare but life-threatening potential cause of bleeding in the intensive care unit. Intensive Care Med 2011;37:1240-9.
  2. Zeitler H, Ulrich-Merzenich G, Goldmann G, Vidovic N, Brackmann HH, Oldenburg J. The relevance of the bleeding severity in the treatment of acquired haemophilia-an update of a single-centre experience with 67 patients. Haemophilia 2010;16:95-101.
  3. Kessler CM. Acquired factor VIII autoantibody inhibitors: Current concepts and potential therapeutic strategies for the future. Haematologica 2000;85 (10 Suppl):57-61.
  4. Franchini M, Gandini G, Di Paolantonio T, Mariani G. Acquired hemophilia A: A concise review. Am J Hematol 2005;80:55-63.
  5. Lusher JM. Screening and diagnosis of coagulation disorders. Am J Obstet Gynecol 1996;175 (3 Pt 2):778-83.
  6. Otaki Y, Kouda R, Fujimura T, Nakatsue T, Wakasugi M, Murakami S, et al. Acute renal failure as a complication of acquired hemophilia due to autoantibody to factor VIII. Clin Exp Nephrol 2010;14:85-9.
  7. Brady JP, Hasbargen JA. A review of the effects of correction of acidosis on nutrition in dialysis patients. Semin Dial 2000;13:252-5.
  8. Ronco C, McCullough P, Anker SD, Anand I, Aspromonte N, Bagshaw SM, et al. Cardio-renal syndromes: Report from the consensus conference of the acute dialysis quality initiative. Eur Heart J 2010;31:703-11.
  9. Huth-Kühne A, Baudo F, Collins P, Ingerslev J, Kessler CM, Lévesque H, et al. International recommendations on the diagnosis and treatment of patients with acquired hemophilia A. Haematologica 2009;94:566-75.
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