Acquired hemophilia A secondary to SARS-CoV-2 pneumonia: a case report.

The acquired hemophilia A (AHA) is a life-threatening condition. The incidence of AHA is extremely low, which requires a multidisciplinary approach to diagnosis and treatment. This is case report of 73-year-old man who presented with AHA secondary to severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) pneumonia. The patient had extensive skin bleeding and hematomas. In the coagulation screening tests activated partial thromboplastin time (APTT) was prolonged with normal prothrombin time (PT), which was indication for further investigation. The APTT in a mixing study with normal plasma did not correct so clotting factors inhibitors were suspected. With signs of bleeding, extremely low factor VIII (FVIII) activity (2%) and presence of FVIII inhibitors, AHA was diagnosed and treatment initiated. Patient was treated with factor eight inhibitor bypassing agent (FEIBA) for three days, followed by long-term corticosteroid and cyclophosphamide therapy. Malignant and autoimmune diseases as the most common causes of AHA were ruled out. The patient had a good response to therapy with gradual normalization of APTT and FVIII activity. To the best of our knowledge, the present case is the first reported case of de novo AHA after SARS-CoV-2 pneumonia. The diagnosis of AHA should be suspected in a patient with bleeding into the skin and mucous membranes without a previous personal and family history of bleeding, and with isolated prolonged APTT. It is important to investigate any isolated prolongation of APTT in cooperation with clinical laboratory experts.

Acquired hemophilia A secondary to SARS-CoV-2 pneumonia: a case report

The acquired hemophilia A (AHA) is a life-threatening condition. The incidence of AHA is extremely low, which requires a multidisciplinary approach to diagnosis and treatment. This is case report of 73-year-old man who presented with AHA secondary to severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) pneumonia. The patient had extensive skin bleeding and hematomas. In the coagulation screening tests activated partial thromboplastin time (APTT) was prolonged with normal prothrombin time (PT), which was indication for further investigation. The APTT in a mixing study with normal plasma did not correct so clotting factors inhibitors were suspected. With signs of bleeding, extremely low factor VIII (FVIII) activity (2%) and presence of FVIII inhibitors, AHA was diagnosed and treatment initiated. Patient was treated with factor eight inhibitor bypassing agent (FEIBA) for three days, followed by long-term corticosteroid and cyclophosphamide therapy. Malignant and autoimmune diseases as the most common causes of AHA were ruled out. The patient had a good response to therapy with gradual normalization of APTT and FVIII activity. To the best of our knowledge, the present case is the first reported case of de novo AHA after SARS-CoV-2 pneumonia. The diagnosis of AHA should be suspected in a patient with bleeding into the skin and mucous membranes without a previous personal and family history of bleeding, and with isolated prolonged APTT. It is important to investigate any isolated prolongation of APTT in cooperation with clinical laboratory experts.

A RESEARCH ON EMIGRATION AS THE FUNDAMENTAL OBSTACLE TO CROATIAN ECONOMIC AND SOCIAL DEVELOPMENT

In the focus of this paper is comprehensive statistical analysis of the public opinion survey on the intention and motives of emigration of young people aged 18 to 40 residing in Croatia and Bosnia and Herzegovina. The emphasis is on the »push« and »pull« emigration factors, dominant directions, contemporary goals of emigration and changes in the demographic structure of emigrants. Two - step stratified random sample was used for hypothesis testing considering the correlations between distributions according to the age of the respondents, their place of residence, level of education, current employment status, satisfaction with the salary of those employed as well as satisfaction with life in domicile state. The paper also intends to shed light on the demographic problem, and in particular the "brain drain" as the fundamental obstacle to Croatian socio-econiomic development. Namely, when highly educated young population emigrates into the more developed EU countries, in accordance with the European free labour market, less developedEU countries have been left with their educational debts. Through their work in more developed EU countries they have unintentionally been contributing to the growing socio-economic development gap. Moreover, after Brexit, the more developed EU countries are in favour of a significant reduction of European cohesion funds which can and should depreciate the growing economic development gap in contemporary EU. All the more so as the Covid-19 pandemic has made that disparity worse many times over.