An Unusual Etiology for Elevation of Activated Partial Thromboplastin Time (aPTT)‎ in SLE : Acquired Hemophilia and Lupus Anticoagulant

Abstract EN

A 60-year-old female who has a history significant for diabetes, depression, and rheumatoid arthritis presented with a progressively enlarging hematoma of the left upper extremity.

She was found to have an enlarging hematoma and an isolated elevation of activated partial thromboplastin time (aPTT).

Lab work-up revealed low factor VIII activity levels and inhibitor titers at 13.38 Bethesda units (BU).

Dilute Russell’s viper venom time (dRVVT) revealed a lupus anticoagulant.

Hemostasis was achieved with factor VIII inhibitor bypassing activity (FEIBA) and inhibitor eradication with-rituxan after the failure of first-line treatment with cyclophosphamide and prednisone.