Acquired factor VIII inhibitor associated with chronic untreated hepatitis C

  • Abdussalam Shredi The Department of Internal Medicine at Texas Tech University Health Sciences Center in Lubbock, TX
  • Benjamin W. Elberson The Department of Internal Medicine at Texas Tech University Health Sciences Center in Lubbock, TX
  • Saif El Nawaa
  • Amr Ismail
Keywords: Factor VIII inhibitor, hepatitis C, hematoma, acquired hemophilia A, autoimmune hemophilia


Acquired inhibitors of coagulation are antibodies that either inhibit the activity or increase the clearance of a clotting factor. A hemorrhagic diathesis is a common clinical manifestation in affected patients. Acquired factor VIII inhibitor – or acquired hemophilia A – is a rare disorder and presents similarly to hemophilia A, though patients are less likely to develop hemarthroses. This inhibition is most commonly due to autoantibodies against coagulation factor VIII. These autoantibodies often occur in pregnancy, autoimmune disorders, solid tumors, and lymphoproliferative syndromes. Several drugs, including penicillins, phenytoin, and sulfa drugs, have also been associated with antibodies to factor VIII. Chronic infection with the hepatitis C virus (HCV), in addition to various degrees of liver inflammation and fibrosis, can have extrahepatic manifestations, especially autoimmune disorders. The most common hematological complications of HCV infection are thrombocytopenia, cryoglobulinemia, and anti-cardiolipin antibodies. A few cases of factor VIII inhibitors occurring in HCV patients have been reported, with a higher incidence after prolonged treatment with interferon-α. Here, we present a case of a patient with chronic untreated HCV infection developing acquired factor VIII deficiency.


Download data is not yet available.


Franchini M, Lippi G. Acquired factor VIII inhibitors. Blood


Franchini M, Gandini G, Di Paolantonio T, Mariani G.

Acquired hemophilia A: a concise review. Am J Hematol


Mulliez SM, Vantilborgh A, Devreese KM. Acquired hemophilia:

a case report and review of the literature. Int J Lab

Hematol 2014;36:398–407.

Franchini M, Capra F, Nicolini N, et al. Drug-induced

anti-factor VIII antibodies: a systematic review. Med Sci

Monit 2007;13:Ra55–61.

Castenskiold EC, Colvin BT, Kelsey SM. Acquired factor

VIII inhibitor associated with chronic interferon-alpha therapy

in a patient with haemophilia A. Br J Haematol 1994;87:


Paul S, Javed U, Tevendale R, Lanford J, Liu R. Acquired

factor VIII inhibitor in an HIV-infected patient after treatment

with pegylated interferon-alpha 2a and ribavirin. Aids.

England 2007:784–5.

Botianu AM, Demian S, Macarie I, Georgescu D, Oltean G,

Bataga S. Acquired haemophilia complicated with gastrointestinal

bleeding and spontaneous iliopsoas muscle haematoma

in a woman with chronic C hepatitis under treatment

with pegylated IFN alpha 2a and ribavirin. J Gastrointestin

Liver Dis 2012;21:93–5.

Campos-de-Magalhaes M, Eduardo Brandao-Mello C, Lucia

Elias Pires M, Cecilia da Fonseca Salgado M, Barcelo de

Brito S, Jose de Almeida A. Factor VIII and IX deficiencies

related to acquired inhibitors in a patient with chronic hepatitis

C virus infection receiving treatment with pegylated

interferon plus ribavirin. Hematology 2011;16:80–5.

Sugishita K, Nagase H, Takahashi T, Takenaka K, Shiratori Y,

Omata M. Acquired factor VIII inhibitor in a non-hemophilic

patient with chronic hepatitis C viral infection. Intern Med


Bitting RL, Bent S, Li Y, Kohlwes J. The prognosis and

treatment of acquired hemophilia: a systematic review and

meta-analysis. Blood Coagul Fibrinolysis 2009;20:517–23.

Ma AD, Carrizosa D. Acquired factor VIII inhibitors: pathophysiology

and treatment. Hematology Am Soc Hematol

Educ Program 2006:432–7.

Zignego AL, Giannini C, Gragnani L, Piluso A, Fognani E.

Hepatitis C virus infection in the immunocompromised host:

a complex scenario with variable clinical impact. J Transl

Med 2012;10:158.

Sagnelli E, Sagnelli C, Pisaturo M, Coppola N. Hepatic flares in

chronic hepatitis C: spontaneous exacerbation vs hepatotropic

viruses superinfection. World J Gastroenterol 2014;20:6707–15.

Knoebl P, Marco P, Baudo F, et al. Demographic and clinical

data in acquired hemophilia A: results from the European

Acquired Haemophilia Registry (EACH2). J Thromb

Haemost 2012;10:622–31.

Delgado J, Jimenez-Yuste V, Hernandez-Navarro F, Villar A.

Acquired haemophilia: review and meta-analysis focused

on therapy and prognostic factors. Br J Haematol 2003;121:


How to Cite
Shredi, A., Elberson, B. W., El Nawaa, S., & Ismail, A. (2018). Acquired factor VIII inhibitor associated with chronic untreated hepatitis C. The Southwest Respiratory and Critical Care Chronicles, 6(23), 17-21.