Follow-up
At six-month, one-year, and two-year follow-up, the patient continued to do well with no new bleeding events. FVIII inhibitor remained undetectable and FVIII activity was persistently normal. He was discharged from hematology after two years of follow-up with apparent resolution of AHA.

Case 2

The second patient was a 11 year-old previously healthy female who presented to the hematology clinic for joint pain and increased bruising. Symptoms began shortly following routine influenza vaccination, when she developed right calf swelling and pain associated with decreased range of motion of her right knee. There was no known trauma to the area, and initial workup was reportedly unremarkable. Over the next two weeks, she experienced swelling and bruising of both forearms unrelated to any trauma. She did not have any personal or family history of significant bleeding disorders.
The patient first presented to hematology clinic one month after symptom onset, and physical examination revealed bilateral forearm ecchymoses, swollen and painful wrists and elbows bilaterally, swelling and ecchymosis of the right calf, and a large effusion of the right knee. Investigations revealed a prolonged PTT (66.5 sec), FVIII activity 7.2% and a FVIII inhibitor (3.8 B.U.; Fig. 2). She was hospitalized and treated with rFVIII 50 U/kg twice daily and prednisone 1mg/kg twice daily. She received three doses of recombinant FVIII with minimal improvement in her symptoms so was switched to rFVIIa. Her soft tissue bleeds markedly improved with rFVIIa and she was discharged home.
The patient received prednisone 1 mg/kg/dose twice daily as an outpatient for ten days and experienced continued symptom improvement, normalization in FVIII activity (104%) and declining inhibitor levels (0.4 B.U.). Steroids were gradually tapered over the course of six weeks, during which time there were no new bleeding events, FVIII activity remained normal, and FVIII inhibitor levels remained undetectable.