Severe Spontaneous Hematoma in an Elderly Female: A Case of Acquired Hemophilia A.

Acquired Hemophilia A (AHA) is a rare but serious autoimmune disorder characterized by the development of autoantibodies against coagulation factor VIII (FVIII), leading to spontaneous bleeding in individuals without a personal or family history of bleeding disorders. The incidence of AHA is approximately 1.5 cases per million per year, with a higher prevalence in the elderly. This case report describes an 87-year-old female who presented with extensive bruising and was found to have profoundly low FVIII levels, and elevated FVIII inhibitor levels confirming a diagnosis of AHA. Management included recombinant activated factor VII (rFVIIa), porcine FVIII (Obizur), corticosteroids, and rituximab, leading to clinical stabilization. We also review diagnostic criteria, the role of inhibitor levels in monitoring, and current treatment guidelines, including the emerging role of emicizumab.