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Arslan Davulcu E, Demirci Z, Yılmaz U, Ar MC, Teke HÜ, Karakuş V, Çiftçiler R, Selim C, Yavaşoğlu İ, Durusoy SS, Okan V, Akdeniz A, Yolcu A, Aydoğdu İ, Güney T, Yılmaz AF, Şahin F. Acquired Hemophilia A In Adults: A Multicenter Study from Turkey. Indian J Hematol Blood Transfus 2023; 39:107-115. [PMID: 36699428 PMCID: PMC9868199 DOI: 10.1007/s12288-022-01556-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 07/04/2022] [Indexed: 01/28/2023] Open
Abstract
Acquired hemophilia A (AHA) is a rare disease caused by autoantibodies inhibiting factor VIII (FVIII) activity. Although the conditionis usually idiopathic, there may be other underlying diseases. Treatment consists of two steps: treatment of acute bleeding and immunosuppression. In this multicenter study, we aimed to demonstrate the clinical characteristics, management details, and survival of AHA patients in Turkey. Data was collected from eleven centers in Turkey. aPTT, FVIII, FVIII inhibitor, and hemoglobin (HB) levels, mixing test results, and demographics at diagnosis, treatment information, adverse events, bleeding episodes during follow-up, relapses, and outcome were analyzed. Twenty-nine patients were analyzed (58.6% female). No underlying disorder could be detected in 14 patients. The most prevalent etiologies were pregnancy, malignancy and infections. The median FVIII activity and FVIII inhibitor titer at diagnosis were 0.7% (0.0-29.4%) and 32.6 BU (0.6-135.6 BU) respectively. Bleeding was severe in 44.8% of patients. The HB value was significantly lower in patients with severe bleeding. Most of the patients (n = 25, 86.2%) had only one bleeding episode without relapse, three patients (10.3%) had two bleeding episodes, and one patient had more than three bleedings. 21 (75%) patients received hemostatic therapy. The use of recombinant FVIIa was slightly higher than activated prothrombin complex concentrate (15 versus 10 patients). Immunosuppressive treatment was initiated in 26 (93%) patients. Regimens containing steroid, cyclophosphamide, and rituximab in different combinations were the most preferred. The median follow-up period was 13 months (2-156 months). Median overall survival was 154.97 months. Four and six-year survival were 90.9 ± 0.8% and 77.9 ± 14.1% respectively. This is a unique study that investigated the demographic characteristics, treatment approaches, and patient survival of AHA in Turkey.
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Affiliation(s)
- Eren Arslan Davulcu
- University of Health Sciences Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Hematology Clinic, Istanbul, Turkey
| | - Zühal Demirci
- Hematology Department, Ege Adult Haemophilia and Thrombosis Center, Ege University Medical Faculty, İzmir, Turkey
| | - Umut Yılmaz
- Division of Hematology, Department of Internal Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Hava Üsküdar Teke
- Internal Medicine, Hematology Department, Eskişehir Osmangazi University Medical Faculty, Istanbul, Turkey
| | - Volkan Karakuş
- Hematology Clinic, University of Health Sciences Antalya Training and Research Hospital, Istanbul, Turkey
| | - Rafiye Çiftçiler
- Hematology Clinic, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | - Cem Selim
- Internal Medicine Hematology Department, Aydın Adnan Menderes University Medical Faculty, Istanbul, Turkey
| | - İrfan Yavaşoğlu
- Internal Medicine Hematology Department, Aydın Adnan Menderes University Medical Faculty, Istanbul, Turkey
| | | | - Vahap Okan
- Department of Hematology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Aydan Akdeniz
- Medical Faculty Hematology Department, Mersin University, Mersin, Turkey
| | - Alkım Yolcu
- Department of Internal Medicine, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - İsmet Aydoğdu
- Hematology Department, Faculty of Medicine, Manisa Celal Bayar University, Mersin, Turkey
| | - Tekin Güney
- Department of Hematology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Asu Fergün Yılmaz
- Hematology Depertmet, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Fahri Şahin
- Hematology Department, Ege Adult Haemophilia and Thrombosis Center, Ege University Medical Faculty, İzmir, Turkey
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Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a very rare type of non-Hodgkin lymphoma, usually affecting elderly patients and characterized by selective infiltration of neoplastic cells within blood vessels' lumina. IVLBCL diagnosed with prostatic involvement is extremely rare. We report a patient of 65 years old, having mostly neurological complaints but diagnosed with IVLBCL upon histopathological examination of transurethral prostate resection material, which revealed large neoplastic cell infiltration totally limited within the lumens of small vessels. By immunohistochemistry, neoplastic cell infiltration was positive with MUM1, bcl-6, and bcl-2 and negative with ALK1, CD10, and CD30, with a high Ki-67 proliferation index. CD34 and CD31 staining showed expression in endothelial cells, highlighting the intravascular nature of neoplastic infiltrate. The patient unfortunately refused to receive treatment and died of the disease 8 months after the diagnosis. IVLBCL, though very rare, should be considered in differential diagnosis of all organ biopsies with intravascular infiltration. Further improvements in the understanding of the pathogenesis and biology of this rare type of lymphoma are mandatory.
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Affiliation(s)
- Nazan Özsan
- Ege University Faculty of Medicine, Department of Pathology, İzmir, Turkey. E-ma-il:
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