Hemophilia A–Acquired During Coronary Artery Bypass Grafting

We report a challenging case of a rare cause of post operative bleeding thatoccurred after the coronary artery by-pass graft procedure. We believe that acquiredhemophilia A was the main culprit. Patient post CABG developed nonsurgicalbleeding with new isolated PTT prolongation. Bleeding was resistant to conventionaltherapy. 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 VIIIinhibitor bypass therapy after which corrected PTT and stopped bleeding. The triadof acquired coagulopathy, noncorrectable PTT, and exclusion of heparin effect, makeacquired hemophilia A the most likely diagnosis