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VOLUME 17 , ISSUE 6 ( December, 2013 ) > List of Articles
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.
License: CC BY-ND 3.0
Published Online: 01-12-2013
Copyright Statement: Copyright © 2013; Jaypee Brothers Medical Publishers (P) Ltd.
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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