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 defi ciencies.
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.