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Brief psychotic disorder — USMLE Step 2 CK MCQ

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HardPsychiatryBrief psychotic disorderUSMLE Step 2 CK

A 76-year-old woman with no bleeding history develops a large spontaneous iliopsoas hematoma. Platelets and PT are normal, aPTT is 92 seconds and does not correct on immediate mixing. Factor VIII activity is 1% with a high-titer factor VIII inhibitor. Which treatment addresses both immediate bleeding and inhibitor eradication?

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Correct answer: A — Use a bypassing hemostatic agent and begin immunosuppressive eradication therapy

This is acquired hemophilia A: new severe bleeding, isolated prolonged aPTT that fails to correct, very low factor VIII and an inhibitor. Major bleeding requires rapid hemostasis with recombinant activated factor VII, activated prothrombin-complex concentrate or recombinant porcine factor VIII, while corticosteroid-based immunosuppression with cyclophosphamide or rituximab is used to eradicate the inhibitor. Vitamin K treats vitamin K deficiency, platelets are normal, heparin worsens bleeding, and desmopressin is insufficient for severe high-titer disease.

Reference: International recommendations on diagnosis and treatment of acquired hemophilia A. https://pmc.ncbi.nlm.nih.gov/articles/PMC7327664/