Thirty one patients were investigated for the main complaint of easy bruising. These patients had normal platelet count with no past history of immune thrombocytopenia or systemic disorders known to predispose to bruising and a negative drug history. The evaluation of these patients included clinical review (history and physical examination) plus coagulation tests consisting of bleeding time, prothrombin time, partial thromboplastin time, thrombin time, fibrinogen level, FXIII screen and platelet functions test. Seven of the paediatric patients had acquired platelet dysfunction with eosinophilia (APDE). In 17 (94.4%) of the 18 adult patients no abnormality was demonstrated. Hence APDE was the commonest cause of easy bruising in children while the haemostatic defect contributing to easy bruising in adults remained unknown.
Acquired haemophilia is a rare clinical condition arising from the spontaneous development of inhibitors to factor VIII. We describe two cases encountered in the University Hospital over the past five years. We also review the literature and discuss the therapeutic difficulties faced in dealing with patients with high levels of inhibitors. In one of these patients we also describe, for the first time in this region, a novel method in managing the acute bleeding episode in acquired haemophilia using recombinant factor VIIa.