Hand swelling is first sign of aquired hemophilia A for new mom: Report
Case shows importance of early recognition of postpartum bleeding
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The case of a new mother who sought emergency treatment for hand swelling highlights the challenges of diagnosing acquired hemophilia.
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For patients, early diagnosis and timely treatment are essential for optimal outcomes, according to researchers.
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This woman's swelling and pain resolved without further complications after a 21-day hospitalization.
A young woman who sought emergency care for severe pain and swelling of her left hand five weeks after giving birth was ultimately diagnosed with acquired hemophilia A — caught early enough that she did not require surgery.
That’s according to a new report detailing the woman’s case, which, the researchers noted, shows that “early recognition” is “essential for optimal outcomes” in people with so-called postpartum acquired hemophilia A, which can occur following childbirth.
For this woman, the hand swelling progressively worsened and a large hematoma — localized bleeding into the body’s tissues — developed in her left forearm. Doctors had first suspected compartment syndrome, a serious condition in which pressure builds up within a muscle section, reducing blood flow and potentially damaging tissue.
But their concern for an underlying bleeding disorder led to further testing and timely hemophilia treatment, according to the report.
“This case emphasizes the importance of recognizing spontaneous postpartum hematomas as potential indicators of acquired hemophilia in the emergency setting,” the researchers wrote.
The report, “Postpartum acquired hemophilia presenting as compartment syndrome: a diagnostic challenge in the emergency department,” was published in the International Journal of Emergency Medicine.
Acquired hemophilia A occurs when self-reactive antibodies mistakenly attack factor VIII (FVIII) — a protein essential for blood clotting — blocking its activity and preventing normal clot formation. Unlike inherited forms of the disease, which are present from birth and often cause bleeding into joints, acquired hemophilia develops suddenly and typically leads to bleeding into soft tissues and muscles.
Its symptoms may include large, painful hematomas, extensive bruising known as ecchymosis, and excessive bleeding after minor injuries or surgeries. In rare cases, bleeding within a limb’s muscle can become severe enough to trigger compartment syndrome.
Woman experienced hand swelling 5 weeks after giving birth
The condition affects about 1.5 people per million each year. In women, as many as 20% of cases are associated with pregnancy, most often appearing one to four months after delivery.
Here, a team of researchers in Israel described the case of a 31-year-old woman who was diagnosed with hemophilia A after showing symptoms that initially raised concern for compartment syndrome. The symptoms occurred about five weeks after the woman had her baby.
Previously healthy, the woman first sought care at a clinic for pain and swelling in her left hand. She reported no recent injury and did not have fever, chills, numbness, or weakness. An ultrasound showed soft tissue swelling, and she was diagnosed with tendinitis and given a cast.
The following day, her symptoms worsened, prompting a visit to the emergency department. Doctors observed significant swelling, bruising, and firmness of her left forearm, consistent with a large hematoma. A smaller hematoma was also noted on her right hand.
Because the swelling was progressing and accompanied by pain and numbness, the doctors grew concerned about possible compartment syndrome. However, the absence of trauma and blood thinner use raised suspicion of an underlying bleeding disorder.
Testing confirmed acquired hemophilia A diagnosis
The team conducted lab tests, which revealed a markedly prolonged partial thromboplastin time (PTT), indicating the blood was taking a long time to clot. Further testing revealed severely reduced FVIII activity — 1.5% of normal, compared with typical activity levels of 70% to 150%.
Additional studies confirmed the presence of self-reactive antibodies targeting factor VIII, establishing an acquired hemophilia A diagnosis.
“In this clinical context, the isolated markedly prolonged PTT with severely reduced factor VIII activity and spontaneous postpartum soft-tissue bleeding confirmed the diagnosis of acquired hemophilia A,” the researchers wrote.
Imaging ruled out a blood clot in the veins but showed early signs of swelling within the forearm muscle compartments.
The woman was admitted to the intensive care unit and treated with medications aimed at both stopping active bleeding and suppressing the underlying abnormal immune activity.
Over the following weeks, her FVIII activity gradually returned to normal. Her swelling and pain resolved, and she did not require surgery for compartment syndrome.
She was discharged home without complications after 21 days of hospitalization and continued outpatient follow-up monitoring.
According to the researchers, this case suggests that “emergency physicians should consider acquired hemophilia A in postpartum patients presenting with unexplained soft-tissue bleeding or compartment-like swelling.”
The team noted that “early recognition, identification of an isolated prolonged PTT, and rapid multidisciplinary coordination” are key to positive outcomes for patients.
