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Acquired factor VIII inhibitor — RACP Adult Medicine MCQ

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HardHaematologyAcquired factor VIII inhibitorRACP Adult Medicine

A 76-year-old with no bleeding history develops a large iliopsoas haematoma. APTT is isolated and non-correcting, factor VIII is 2%, and a high-titre factor VIII inhibitor is detected. Haemoglobin is falling. What is the immediate treatment strategy?

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Correct answer: D — Start bypass haemostasis and inhibitor-eradication immunosuppression in parallel

Explanation lettering: B = shown as A · D = shown as B · E = shown as D · A = shown as E

E is correct because acquired haemophilia with major bleeding requires haemostatic treatment—often a bypassing agent or suitable factor strategy—plus immunosuppression to eradicate the inhibitor. A is usually ineffective against a high-titre inhibitor and postpones eradication. B neither neutralises the inhibitor nor treats a normal platelet compartment. C leaves a major bleed uncontrolled while immunosuppression takes effect. D is inadequate monotherapy for a falling haemoglobin and deep haematoma. Response is assessed clinically and by haemoglobin because APTT does not reliably measure bypassing-agent efficacy.

Reference: Australian Haemophilia Centre Directors’ Organisation, Australian haemophilia guidelines: https://www.ahcdo.org.au/s/HaemophiliaGuidelines-interactive-updated-260317v2.pdf