Acquired Hemophilia A: A Case Report on a Rare Disease Manifesting as Persistent Hematuria

Hemophilia A is most commonly a genetic clotting disorder that is caused by a decrease or lack of activity of clotting factor VIII. Acquired hemophilia, a rarer subset can occur later on in life. The incidence rate of the latter subtype is estimated to affect one per million cases a year. Given the rarity of the disease, the associated hemoglobin and hematocrit reduction seen from this can easily be missed and attributed to concomitant disorders such as hematuria. Our patient initially presented with persistent hematuria, was treated with multiple rounds of antibiotics, and underwent a plethora of urological studies with no resolution or explanation of her symptoms. It wasn't until her ICU admission that coagulation studies were reviewed in depth and workup for hemophilia A began. The American Urologic Association's hematuria workup is currently limited to the genitourinary system with no consideration for hematological disorders. We believe that the medical community may benefit from further research in this area in order to avoid mismanaging patients medically and thus minimize morbidity and mortality.