An Initial Diagnosis of Acquired Hemophilia A in an Elderly Male With a Neck Hematoma.

Acquired hemophilia A (AHA) is a rare hematologic disorder that most commonly presents in the elderly. Hematomas due to AHA are commonly found in the extremities and uncommonly found in the head and neck region. We present an atypical presentation of AHA in an elderly male with a neck hematoma secondary to a ground-level fall. In addition to older age, common associated characteristics with AHA include malignancy and a history of autoimmune disorder. Timely diagnosis of AHA is critical, as delays in treatment can adversely affect outcomes. Initial non-surgical work-up can include laboratory testing with activated partial thromboplastin time and cross-sectional imaging, although these modalities are not diagnostic. Hematologic experts should be consulted as soon as possible if AHA is suspected. Surgical intervention may be necessary to obtain hemostasis depending on the severity of the presentation, and perioperative management should be altered accordingly for hemostatic support if a diagnosis of AHA is present. In cases of cervical hematomas in patients with AHA, otolaryngologic surgeons can aid in management with serial assessments of the airway. Although many coagulopathies can manifest with spontaneous and excessive bleeding, AHA should be suspected in any patient with relevant risk factors, no history of bleeding disorders or anticoagulant use, bleeding in an unusual location, and/or bleeding that is disproportionate to the mechanism of trauma. This case highlights the importance of maintaining diagnostic suspicion for AHA and underscores the need for prompt, coordinated multidisciplinary management of this disease.