OBJECTIVES : Acquired hemophilia A (AHA) is an extremely rare, but potentially life-threatening bleeding disorder caused by autoantibodies against human coagulation factor VIII. AHA may lead to spontaneous or trauma induced bleeds, treated with bypassing agents. New and successful therapies had been launched in the last decade. Several manufacturers drove awareness campaigns in Germany to push detection of potential patients. Here we examine the change in frequency of AHA in-hospital coding, based German DRG-data.

METHODS : Reports from German DRG-Institute (InEK), Statistical Office (DESTATIS) and German hospital quality reports 2010-2018 were analyzed for AHA. Analysis with Microsoft-Access 2019.

RESULTS : Cases with a main and secondary diagnosis of AHA (D68.31, ICD10-GM) increased from 215 (2010) to 633 (2015) and stay stable around 500 annually ever since (+132%). Main diagnosis rose from 29 (2010) to 142 (2015) and remains ever since between 139 and 144 (+396%). Gender distribution (58.9% male) remained stable over time, extremes 2010: 54.4% male and 2016: 61.3% male. The average length of hospitalization decreased slightly from 22.3 days (2010) to 19.2 days (2018; -14%). All age groups between age of 60 and 90 had average lengths of stay between 20 and 24 days. Average age of patients was constantly around 70 years (2018: 69.3), the median age increased from 73 (2014) to 77 (2018). Analysis of living place of patients revealed a higher hospitalization rate in states with higher rate of hemophilia centers.

CONCLUSIONS : We observed a steep increase in documented hospital cases with AHA between 2010 and 2015, thereafter the annual figures remain very constant. It may be concluded that the various awareness campaigns worked, but that a steady level was reached in 2015. The stable age, gender, and length of stay distribution support the assumption that more cases of AHA had been detected. National registration of AHA might deepen the insights.