Acquired Hemophillia and Negative Pressure Wound Therapy: Can It Be Done?

Acquired hemophilia, a rare autoimmune condition in which the body forms antibodies that attack clotting factors, can have significant implications for wound care as bleeding is a serious concern.  In this case study we present the courses of treatment for three individuals who required wound care in the context of their acquired hemophilia.

The wounds in these case reports were either a direct result of their acquired hemophilia or unrelated to it but complicated by it.  The first patient developed a significant hematoma after trauma to the leg, the second required fasciotomies due to other medical issues, and the third developed a stage 4 sacral-coccygeal pressure ulcer during a prolonged admission. All three patients required Negative Pressure Wound Therapy (NPWT) as part of their wound care regimen.

There are no case reports in the literature regarding the safe use of NPWT in the acquired hemophilia host. This management was selected after careful considerations of potential bleeding and further injury and an exhaustive assessment of the host. Pertinent specialists were consulted at all stages of wound care interventions.

All three patients responded very well to NPWT.  Their wounds decreased in size, and  granulation tissue covered the majority of the wound base. Bleeding was minimized with the use of a wound interface, along with lower than usual suction (-75 mm hg). Additionally, bleeding was managed with the use of Anti-Inhibitor Coagulant Complex and Tranexamic Acid, along with careful and ongoing monitoring of the patients.