Bleeding and Myocardial Infarction in Acquired Factor VIII Deficiency

Patient presentation: An 80-year-old man presented to the emergency department with severe bruising of both arms and abdomen (Figure 1). The patient's past medical history included systemic hypertension without previous bleeding or bruising events or a family history of hematologic disease. He had received the mRNA COVID-19 vaccine 3 days before presentation. Laboratory evaluation demonstrated acute anemia (hemoglobin, 8.9 g/dL [reference, 13.5-18.0 g/dL]) and elevated partial thromboplastin time of 107 s (reference: 24-37 s) which did not appreciably correct with a mixing study; additional biochemical data were collected including chromogenic factor VIII (FVIII) activity <1% (reference: 50-150%) and FVIII inhibitor level (84 Bethesda units [reference: <0.5 Bethesda units]). The patient was diagnosed with acquired FVIII deficiency. © 2023 Lippincott Williams and Wilkins. All rights reserved.