Mysterious bruises

S. Borra, H. Chen, C. P. Cheung, J. Jiao

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


A 69-year-old man presented with multiple spontaneous bruises in the past 2 weeks. Several large-sized hematomas were found on examination. The initial investigation revealed a prolonged activated partial thromboplastin time (aPTT) with normal platelet count and international normalized ratio. Further investigation revealed a low factor VIII activity secondary to presence of factor VIII inhibitor, making the diagnosis of acquired hemophilia A. Further work-up revealed that pernicious anemia was present and acted as an associated disease. After steroids therapy, his aPTT was normalized and the factor VIII inhibitor titer became undetectable. 2 months later, a relapse occurred and new hematomas appeared at his retropharyngeal space and left arm. His bleeding was controlled by administration of recombinant factor VIIa, and a combined therapy of intravenous steroids and rituximab was given to eradicate the inhibitor. The approach to workup of bleeding disorders as well as treatment of acquired hemophilia A are herein discussed.

Original languageEnglish
Pages (from-to)221-224
Number of pages4
JournalJournal of Postgraduate Medicine
Issue number3
StatePublished - Jul 2012


  • Acquired hemophilia A
  • autoimmune disorders
  • diagnosis
  • pernicious anemia
  • treatment


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