Surgery-associated factor VIII inhibitors in patients without hemophilia

The acquisition of antibodies to factor VIII (ie, factor VIII protein) by p atients without hemophilia is associated with conditions such as pregnancy, lymphoma, and autoimmune disorders. We present three patients who acquired factor VIII antibodies in the postoperative setting. Preoperatively, none gave a history of bleeding even with past surgeries and all had normal coag ulation tests. Within days of surgery (bowel resection, cholecystectomy, co ronary bypass), a bleeding diathesis emerged with prolonged partial thrombo plastin time, decreased factor VIII levels, and demonstrable factor VIII an tibodies. All patients required multiple blood transfusions and urgent re- exploration for hemostatic control. All were treated with high dose human f actor VIII infusions, corticosteroids, and various forms of immunosuppressi on. We wish to raise awareness of surgery as a precipitating cause of acqui red hemophilia, which is something to be considered with unusual postoperat ive bleeding. This syndrome is remarkable for its abrupt onset within days of surgery, dramatic bleeding, subsequent persistence, but potential revers al by immunosuppression.