Acquired hemophilia A (AHA) is a rare hemorrhagic disorder caused by autoantibodies against factor VIII (FVIII). An 80-year-old woman presented multiple bruises on her upper and lower extremities, along with gross hematuria. Extensive ecchymosis and swelling were observed on the buttocks. She had anemia and normal platelet count. The initial coagulation results showed prolonged activated partial thromboplastin time (aPTT, 68.5 seconds) and normal prothrombin time. According to the mixing test, we observed a decreased FVIII activity (2%), increased factor VIII inhibitor (FVIII-I) titer (74.4 BU), and negative lupus anticoagulant. AHA was diagnosed based on late onset bleeding and increased FVIII-I titer. Additionally, she met the criteria for systemic lupus erythematosus (oral ulcer, photosensitivity, renal disorder, and positivity for antinuclear and anti-β2-glycoprotein-I antibodies). She was started on oral prednisolone for FVIII-I eradication. Post-treatment, her bleeding tendency, aPTT (47.3 seconds), and FVIII-I titer decreased (1.24 BU), and FVIII activity increased (10%).
Aged, 80 and over ; Anemia ; Autoantibodies ; Buttocks ; Contusions ; Ecchymosis ; Factor VIII ; Female ; Hematuria ; Hemophilia A* ; Hemorrhage ; Hemorrhagic Disorders ; Humans ; Lower Extremity ; Lupus Coagulation Inhibitor ; Lupus Erythematosus, Systemic* ; Partial Thromboplastin Time ; Platelet Count ; Prednisolone ; Prothrombin Time ; Ulcer

BACKGROUND: This study aimed to analyze the barriers affecting the utilization of antenatal care (ANC) among Senegalese mothers. METHODS: Health facility staffs were surveyed to examine the availability coverage of ANC (infrastructural capacity of health posts to handle maternal and newborn healthcare). A total of 113 women of childbearing age were surveyed to identify factors associated with the accessibility coverage (physical, economic, and information accessibility factors), acceptability coverage (socio-cultural features, social acceptance, and language), and effectiveness coverage (ratio of mothers having completed 4 visits) of ANC. Further, to identify the socio-cultural factors and the specific characteristics of the barriers, 5 focus group discussions were conducted with women of childbearing age, their husbands and mothers-in-law, community health workers, and health facility staff. The effectiveness coverage of ANC was analyzed by reviewing materials from the District Health Information System 2 of Senegal. RESULTS: Key barriers of ANC utilization were associated with acceptability coverage. ANC during early pregnancy was avoided owing to the negative social stigma surrounding miscarriage. The survey results indicated an extremely high miscarriage rate of 30.9% among the participants. The social stigma towards unmarried mothers caused them to hide their pregnancy, which deterred ANC utilization. The husband was the final decision maker and social supporter on ANC utilization. CONCLUSION: To promote the utilization of ANC services among pregnant women in Senegal, it is important to alleviate the social stigma towards miscarriages and unmarried mothers, and to provide greater social support for pregnancies and newborn deliveries within family.
Abortion, Spontaneous ; Community Health Workers ; Female ; Focus Groups ; Health Facilities ; Health Information Systems ; Humans ; Illegitimacy ; Infant Health ; Infant, Newborn ; Maternal Health ; Mothers ; Patient Acceptance of Health Care ; Pregnancy ; Pregnant Women ; Senegal ; Social Distance ; Social Stigma ; Spouses