Lesson of the Week: Acquired haemophilia: an important but often unrecognised cause of bleeding in elderly people

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Abstract
Acquired haemophilia is a rare condition caused by the spontaneous acquisition of antibodies to clotting factor VIII. Although the reported incidence is 1 in 1000000,1 the diagnosis may be missed and the condition may in fact be more common. We present two cases and discuss the reasons for the different outcomes. ### Case 1 A 79 year old man presented with epigastric pain and melaena. He had a history of melaena from a bleeding duodenal ulcer, diagnosed on barium meal examination 20 years previously, and a hiatus hernia, diagnosed on endoscopy two years previously. On admission his blood haemoglobin concentration was 96 g/l and he required transfusion. Endoscopy showed superficial ulceration in a deformed duodenal cap, hiatus hernia, and mild oesophagitis. Despite treatment with ranitidine he had two further episodes of serious gastrointestinal bleeding. During a third episode his haemoglobin concentration fell to 51 g/l and he developed a widespread ecchymotic rash. A clotting screen showed a prolonged activated partial thromboplastin time of 72.9 (normal range 26-36) and a …

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