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Case Reports in Hematology
Volume 2014, Article ID 626831, 4 pages
http://dx.doi.org/10.1155/2014/626831
Case Report

Acquired Factor XI Inhibitor Presenting as Spontaneous Bilateral Subdural Hematoma in an Elderly Patient

1Department of Internal Medicine, “S. Giovanni di Dio” Hospital, Via di Torregalli, 3-50143 Florence, Italy
2Department of Clinical Chemistry, “S. Giovanni di Dio” Hospital, Via di Torregalli, 3-50143 Florence, Italy

Received 31 July 2014; Accepted 16 October 2014; Published 6 November 2014

Academic Editor: Kazunori Nakase

Copyright © 2014 Natale Vazzana et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Development of autoantibodies against coagulation factors is an uncommon bleeding disorder associated with cancer, autoimmune conditions, pregnancy, or no apparent disease. Spontaneous FVIII inhibitors are the most frequently encountered; those against FXI have been only anecdotally reported. We report a case of acquired FXI inhibitor presenting as fatal intracranial spontaneous bleeding in an elderly patient with history of cancer and previous transfusions. Few cases of acquired FXI inhibitor have been reported in association with connective tissue disease, cancer, or surgery. Bleeding includes mucocutaneous bleeding, postsurgical hemorrhage, or life-threatening events. Treatment consists of arresting the bleeding and inhibitor eradication. High degree of suspicion is essential to promptly diagnose and treat this uncommon condition.