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Ryšánková K, Gumulec J, Grepl M, Krhut J. Acquired haemophilia as a complicating factor in treatment of non-muscle invasive bladder cancer: A case report. World J Clin Cases 2023; 11:5338-5343. [PMID: 37621596 PMCID: PMC10445081 DOI: 10.12998/wjcc.v11.i22.5338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/16/2023] [Accepted: 06/26/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Acquired haemophilia (AH) is a serious autoimmune haematological disease caused by the production of auto-antibodies against coagulation factor VIII. In some patients, AH is associated with a concomitant malignancy. In case of surgical intervention, AH poses a high risk of life-threatening bleeding. CASE SUMMARY A 60-year-old female patient with multiple recurrences of non-muscle invasive bladder cancer underwent transurethral tumour resection. A severe haematuria developed postoperatively warranting two endoscopic revisions; however, no clear source of bleeding was identified in the bladder. Subsequent haematological examination established a diagnosis of AH. Treatment with factor VIII inhibitor bypass activity and immunosuppressive therapy was initiated immediately. The patient responded well to the therapy and was discharged from the hospital 21 d after the primary surgery. At the 38-mo follow-up, both AH and bladder cancer remained in complete remission. CONCLUSION AH is a rare, life-threatening haematological disease. AH should be considered in patients with persistent severe haematuria or other bleeding symptoms, especially if combined with isolated activated partial thromboplastin time prolongation.
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Affiliation(s)
- Kateřina Ryšánková
- Department of Urology, University Hospital Ostrava, Ostrava 70852, Czech Republic
- Department of Surgical Studies, Faculty of Medicine, Ostrava University, Ostrava 70300, Czech Republic
| | - Jaromír Gumulec
- Department of Haematooncology, University Hospital Ostrava, Ostrava 70852, Czech Republic
- Department of Internal Medicine, Faculty of Medicine, Ostrava University, Ostrava 70300, Czech Republic
| | - Michal Grepl
- Department of Urology, University Hospital Ostrava, Ostrava 70852, Czech Republic
- Department of Surgical Studies, Faculty of Medicine, Ostrava University, Ostrava 70300, Czech Republic
| | - Jan Krhut
- Department of Urology, University Hospital Ostrava, Ostrava 70852, Czech Republic
- Department of Surgical Studies, Faculty of Medicine, Ostrava University, Ostrava 70300, Czech Republic
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2
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Ryšánková K, Gumulec J, Grepl M, Krhut J. Acquired haemophilia as a complicating factor in treatment of non-muscle invasive bladder cancer: A case report. World J Clin Cases 2023; 11:5332-5337. [DOI: 10.12998/wjcc.v11.i22.5332] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/16/2023] [Accepted: 06/26/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Acquired haemophilia (AH) is a serious autoimmune haematological disease caused by the production of auto-antibodies against coagulation factor VIII. In some patients, AH is associated with a concomitant malignancy. In case of surgical intervention, AH poses a high risk of life-threatening bleeding.
CASE SUMMARY A 60-year-old female patient with multiple recurrences of non-muscle invasive bladder cancer underwent transurethral tumour resection. A severe haematuria developed postoperatively warranting two endoscopic revisions; however, no clear source of bleeding was identified in the bladder. Subsequent haematological examination established a diagnosis of AH. Treatment with factor VIII inhibitor bypass activity and immunosuppressive therapy was initiated immediately. The patient responded well to the therapy and was discharged from the hospital 21 d after the primary surgery. At the 38-mo follow-up, both AH and bladder cancer remained in complete remission.
CONCLUSION AH is a rare, life-threatening haematological disease. AH should be considered in patients with persistent severe haematuria or other bleeding symptoms, especially if combined with isolated activated partial thromboplastin time prolongation.
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Affiliation(s)
- Kateřina Ryšánková
- Department of Urology, University Hospital Ostrava, Ostrava 70852, Czech Republic
- Department of Surgical Studies, Faculty of Medicine, Ostrava University, Ostrava 70300, Czech Republic
| | - Jaromír Gumulec
- Department of Haematooncology, University Hospital Ostrava, Ostrava 70852, Czech Republic
- Department of Internal Medicine, Faculty of Medicine, Ostrava University, Ostrava 70300, Czech Republic
| | - Michal Grepl
- Department of Urology, University Hospital Ostrava, Ostrava 70852, Czech Republic
- Department of Surgical Studies, Faculty of Medicine, Ostrava University, Ostrava 70300, Czech Republic
| | - Jan Krhut
- Department of Urology, University Hospital Ostrava, Ostrava 70852, Czech Republic
- Department of Surgical Studies, Faculty of Medicine, Ostrava University, Ostrava 70300, Czech Republic
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Stammler R, Ackermann F, Vasse M, Verrat A, David A, Horodyckid C, Gratieux J, Marroun I, Groh M, Roumier M, Paule R. Life-threatening chlorpromazine-induced acquired haemophilia A in a patient with a cavernous malformation involving the medulla oblongata. Rev Med Interne 2022:S0248-8663(22)00631-2. [PMID: 36075795 DOI: 10.1016/j.revmed.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/26/2022] [Accepted: 08/24/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Chlorpromazine is a commonly used drug in several medical conditions associated with a wide range of side effects. Few cases of hemostatic disorder have been reported in the literature. CASE REPORT A 39-year-old man had previously been diagnosed with a cavernous malformation of the medulla oblongata. Chlorpromazine was started to treat persistent hiccups. Twenty days later, the patient presented hepatitis and a pruritic rash. Haemostasis tests revealed a prolonged partial thromboplastin time associated with isolated decrease of factor VIII level and anti-factor VIII antibodies. Magnetic resonance imaging revealed recent asymptomatic bleeding. Introduction of eptacog alfa and prednisone allowed clinical and biological improvement as well as a prolonged remission after 12 months of follow-up.
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Al-Banaa K, Gallastegui-Crestani N, von Drygalski A. Anticoagulation for Stroke Prevention after Restoration of Haemostasis with Emicizumab in Acquired Haemophilia A. Eur J Case Rep Intern Med 2021; 8:002984. [PMID: 34912741 PMCID: PMC8667998 DOI: 10.12890/2021_002984] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 11/05/2022] Open
Abstract
Acquired haemophilia A (AHA) is a rare haemorrhagic disorder caused by the development of autoantibodies inhibiting factor VIII function. It predominantly affects the elderly, who are often burdened with a considerable number of comorbidities, and can result in life-threatening bleeding. The management of AHA consists of two aspects: inhibitor eradication with an immunomodulator and bleed control with a bypassing agent. Here we present a case of AHA with a high titre inhibitor in a patient with extensive comorbidities and atrial fibrillation in whom inhibitor eradication could not be achieved within a few weeks using corticosteroids alone. Due to coronavirus disease (COVID)-19 restrictions and complications of care, emicizumab offered an effective and convenient therapy, not only sparing the need for continued and intensified inhibitor eradication, but also allowing anticoagulation for stroke prophylaxis. LEARNING POINTS Emicizumab may offer a suitable option for bleeding prophylaxis when inhibitor eradication is not achievable with immunotolerance treatment, especially in the age of the COVID-19 pandemic when the consequences of immunosuppression can be detrimental.Bleeding prophylaxis with emicizumab may enable long-term anticoagulation in patients with acquired haemophilia A during inhibitor eradication.The prothrombotic risks of emicizumab are not yet sufficiently characterized.
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Affiliation(s)
- Kadhim Al-Banaa
- Department of Hematology/Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | | | - Annette von Drygalski
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, CA, USA.,Department of Molecular Medicine, Scripps Research Institute, La Jolla, CA, USA
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Taher A, Al Mahmasani L, Aadra A, Yazbeck P, Saad GA, Nasr F, Habib R, Chalfoun A, Haddad F. Assessment of Lebanese healthcare professionals' awareness on acquired haemophilia: a cross-sectional study. ACTA ACUST UNITED AC 2021; 26:83-87. [PMID: 33427128 DOI: 10.1080/16078454.2020.1869885] [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] [Indexed: 10/22/2022]
Abstract
BACKGROUND Acquired haemophilia A (AHA) is a rare immune-mediated disorder characterised by the development of autoantibodies against factor VIII. Morbidity and mortality are in general high due to multiple factors including the age of the patient, underlying diseases, toxic effects of available treatments and bleeding itself. OBJECTIVE To assess the awareness about AHA among healthcare professionals (HCPs) in Lebanon where patients can present to non-haematologists with life-threatening bleeding disorders. METHODS A cross-sectional survey was conducted in September and October 2017 all over Lebanon among HCPs. The survey covered: (i) the geographic area of practice and specialty; (ii) bleeding disorders encountered within the last 2 years; (iii) assessment of knowledge on AHA; and (iv) importance of increasing awareness on AHA among HCPs. RESULTS A total of 362 participants completed and returned the questionnaire (response rate 100%). The majority of the HCPs were practicing in Beirut (n=164; 45.3%) and were internists (n=106; 29.3%). 332 (93%) HCPs have encountered patients with bleeding problems within the last 2 years all over Lebanon. 327 (92.1%) HCPs agreed that increasing awareness on AHA among health care professionals is important. HCPs gave an average of 75.9% of correct answers on the survey. CONCLUSIONS Appropriate treatment and diagnosis are essential when dealing with AHA. Knowledge gaps exist in the clinical practice when dealing with patients who have AHA. This study shows the need for increasing awareness about AHA among HCPs in Lebanon regarding the diagnosis and treatment of this disorder.
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Affiliation(s)
- Ali Taher
- Department of Internal Medicine, Division of Haematology-Oncology, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Layal Al Mahmasani
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdallah Aadra
- Maternal Foetal Medicine, Medical Centre, Tripoli, Lebanon
| | - Patricia Yazbeck
- Anaesthesia and Critical Care Department, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Georges Abi Saad
- Trauma & Critical Care Surgery, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Fadi Nasr
- Department of Haematology-Oncology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Rita Habib
- Medical Affairs, Novo Nordisk, Beirut, Lebanon
| | | | - Fadi Haddad
- Saint Joseph Medical School, Beirut, Lebanon
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Mangin MA, Lienhart A, Gouraud A, Roux S, Hodique F, Jouen F, Balme B, Dalle S, Debarbieux S. Onset of acquired haemophilia A after omalizumab treatment in severe bullous pemphigoid - a report on two cases successfully treated with mycophenolate mofetil. Ann Dermatol Venereol 2021; 148:57-59. [PMID: 33461795 DOI: 10.1016/j.annder.2020.09.577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/24/2020] [Accepted: 09/30/2020] [Indexed: 10/22/2022]
Affiliation(s)
- M-A Mangin
- Service de dermatologie, hospices civils de Lyon, centre hospitalier Lyon-Sud, 69495 Pierre-Bénite cedex, France.
| | - A Lienhart
- Hospices civils de Lyon, groupement hospitalier Est, centre régional de traitement de l'Hémophilie, 69500 Bron cedex, France
| | - A Gouraud
- Pharmacovigilance, hospices civils de Lyon, centre hospitalier Lyon Sud, 69495 Pierre-Bénite cedex, France
| | - S Roux
- Service de maladies infectieuses et tropicales, hospices civils de Lyon, hôpital de la Croix Rousse, 69004 Lyon, France
| | - F Hodique
- Service de maladies infectieuses et tropicales, hospices civils de Lyon, hôpital de la Croix Rousse, 69004 Lyon, France
| | - F Jouen
- Biologie médicale, centre hospitalier de Rouen, hôpital Charles-Nicole, 76031 Rouen cedex, France
| | - B Balme
- Service d'anatomopathologie, hospices civils de Lyon, centre hospitalier Lyon Sud, 69495 Pierre-Bénite cedex, France
| | - S Dalle
- Service de dermatologie, hospices civils de Lyon, centre hospitalier Lyon-Sud, 69495 Pierre-Bénite cedex, France
| | - S Debarbieux
- Service de dermatologie, hospices civils de Lyon, centre hospitalier Lyon-Sud, 69495 Pierre-Bénite cedex, France
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Zanon E, Pasca S, Spiezia L, Poletto F, Gherardi S, Simioni P. Acquired haemophilia A, concomitant acute myocardial infarction and urgent major surgery: How to successfully treat a critical patient with rpFVIII (Obizur®). Thromb Res 2020; 195:125-127. [PMID: 32683151 DOI: 10.1016/j.thromres.2020.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/18/2020] [Accepted: 07/06/2020] [Indexed: 01/19/2023]
Abstract
Association of acute myocardial infarction (AMI) and acquired haemophilia A (AHA) is extremely rare, and very difficult to treat, if the patient then presents several serious comorbidities and must undergo an urgent major surgery, the correct choice of haemostatic therapy is essential to avoid potentially life-threatening adverse events for the patient. The recombinant porcine FVIII (rpFVIII) is considered, together with the bypassing agents, as first-line therapy for the AHA, but compared to these it presents a reduced thromboembolic risk which makes it safer in patients who already present at the onset of haemorrhagic event an underlying cardiovascular disease. Haemorrhagic and thrombotic events are always to be taken into consideration in the case of surgery, but in the case of patients with concomitant acquired haemophilia the risk of having serious bleeding has further increase. Today there have been no reports of surgeries carried out under Obizur® coverage. We are reporting the successful case of an elderly critical patient with acquired haemophilia A and concomitant myocardial infarction, treated with rpFVIII and in which an urgent major surgery under coverage of this dug was performed for the first time.
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Affiliation(s)
- Ezio Zanon
- Haemophilia Centre, Department of Medicine, University Hospital of Padua, Italy.
| | - Samantha Pasca
- Haemophilia Centre, Department of Medicine, University Hospital of Padua, Italy
| | - Luca Spiezia
- Centre for Haemorrhagic and Thrombotic Diseases, Department of Medicine, University Hospital of Padua, Italy
| | - Francesco Poletto
- Centre for Haemorrhagic and Thrombotic Diseases, Department of Medicine, University Hospital of Padua, Italy
| | - Simone Gherardi
- Centre for Haemorrhagic and Thrombotic Diseases, Department of Medicine, University Hospital of Padua, Italy
| | - Paolo Simioni
- Centre for Haemorrhagic and Thrombotic Diseases, Department of Medicine, University Hospital of Padua, Italy
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Möhnle P, Pekrul I, Spannagl M, Sturm A, Singh D, Dechant C. Emicizumab in the Treatment of Acquired Haemophilia: A Case Report. Transfus Med Hemother 2019; 46:121-123. [PMID: 31191199 DOI: 10.1159/000497287] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 10/09/2018] [Accepted: 01/26/2019] [Indexed: 01/30/2023] Open
Abstract
The prognosis of acquired haemophilia A (AHA) is severe and treatment options are limited. Emicizumab is a novel bispecific humanized monoclonal antibody in the treatment of inherited AHA with inhibitors. An 83-year-old AHA patient with congestive heart failure and a high risk for thromboembolic and cardiac events who had initially been treated successfully with steroids and substitution of recombinant B-domain-deleted porcine FVIII developed severe bleeding complications and a secondary increase in inhibitor titres after 4 weeks of treatment. Conventional therapeutic strategies failed, and the patient was subsequently treated with emicizumab on off-label and named patient use premises. After the application of emicizumab, the clinical conditions stabilized and no further substitution of coagulation factors was needed. The patient could be discharged and survived 36 days in a cardiac rehabilitation centre without indications for spontaneous bleeding or thromboembolic events. We suggest that the effects of emicizumab in acquired haemophilia should be evaluated in clinical trials.
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Affiliation(s)
- Patrick Möhnle
- Department of Transfusion Medicine, Cellular Therapeutics and Hemostaseology, Department of Anaesthesiology, Hospital of Ludwig Maximilian University, Munich, Germany
| | - Isabell Pekrul
- Department of Transfusion Medicine, Cellular Therapeutics and Hemostaseology, Department of Anaesthesiology, Hospital of Ludwig Maximilian University, Munich, Germany
| | - Michael Spannagl
- Department of Transfusion Medicine, Cellular Therapeutics and Hemostaseology, Department of Anaesthesiology, Hospital of Ludwig Maximilian University, Munich, Germany
| | - Andreas Sturm
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, University of Munich, Munich, Germany
| | - Delila Singh
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, University of Munich, Munich, Germany
| | - Claudia Dechant
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, University of Munich, Munich, Germany
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9
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Pasca S, Ambaglio C, Rocino A, Santoro C, Cantori I, Zanon E. Combined use of antifibrinolytics and activated prothrombin complex concentrate (aPCC) is not related to thromboembolic events in patients with acquired haemophilia A: data from FAIR Registry. J Thromb Thrombolysis 2018; 47:129-133. [PMID: 30267246 DOI: 10.1007/s11239-018-1750-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Antifibrinolytics combined with aPCC are not routinely administered to patients with acquired hemophilia A due to increased thrombotic risk. This association normalizes clot stability, and improves the efficacy of therapy, but can increase the risk of severe side effects. Due to these premises it has always raised doubts and perplexities in the clinics. We now report the data of the "FEIBA® on acquired haemophilia A Italian Registry (FAIR Registry)", a retrospective-prospective study that included 56 patients. This is the first study that assessed the clinical response of the combination of aPCC and antifibrinolytic agents in patients with acquired haemophilia A. A total of 101 acute bleeds were treated with aPCC. Antifibrinolytic agents were used in the treatment of 39.6% of total bleeds, based on both, a clinical assessment and an evaluation of bleeding. Twenty-five of the 30 patients (57.1%) treated with antifibrinolytic drugs showed serious co-morbidity. Among them, 40% presented severe cardiovascular diseases. All bleeds treated with combined therapy had a shorter duration of treatment (mean reduction 16.3%). All the treated patients presented a good tolerability and no arterial or venous thromboembolic events were reported. In our retrospective registry the combination of antifibrinolytics and aPCC appears safe and effective in the treatment of patients with AHA, especially in the case of severe and life-threatening bleeding, but this hypothesis needs to be confirmed in adequate, larger clinical trials.
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Affiliation(s)
- S Pasca
- Haemophilia Centre, University Hospital of Padua, Via Giustiniani, 35128, Padua, Italy.
| | - C Ambaglio
- Haemophilia Centre, S.Matteo Hospital of Pavia, Pavia, Italy
| | - A Rocino
- Haemophilia and Thrombosis Centre, S.Giovanni Bosco Hospital of Neaples, Naples, Italy
| | - C Santoro
- Cellular Biotecnology and Haematology Department, Umberto I University Hospital of Rome, Rome, Italy
| | - I Cantori
- Centre of Coagulation Diseases, Hospital of Macerata, Macerata, Italy
| | - E Zanon
- Haemophilia Centre, University Hospital of Padua, Via Giustiniani, 35128, Padua, Italy
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de Vitry A, Valois A, Weinborn M, Dupuy-de Fonclare AL, Cuny JF, Barbaud A, Schmutz JL. [ Acquired haemophilia A: two cases]. Ann Dermatol Venereol 2014; 141:441-5. [PMID: 24951143 DOI: 10.1016/j.annder.2014.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/03/2013] [Revised: 02/17/2014] [Accepted: 03/03/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Acquired haemophilia A (AH) is an uncommon bleeding disorder that presents as multiple, disseminated spontaneous subcutaneous bleeds. Diagnosis may be made on the basis of prolonged activated partial thromboplastin time (aPTT). The severity of the disease is associated with the low risk of haemoglobin levels and with potential links with other diseases. OBSERVATIONS Two men were hospitalized for extensive and spontaneous subcutaneous hematoma. In both cases, the International Normalized Ratio (INR) was normal, but aPTT was 3 times higher than normal. Autoantibodies against coagulation factor VIII confirmed the diagnosis of AH. The patients received immunomodulatory treatment. In one patient, diffuse large B-cell lymphoma was discovered one year after successful treatment of AH. DISCUSSION AH may be revealed by areas of bruising, subutaneous haematomas mimicking erythema nodosum, and muscle pain. APTT results alone can prompt the biologist to screen for factor VIII inhibitors. Aside from the risk of fatal bleeding, in half of all cases, the prognosis is determined by associated disorders such as blood dyscrasias, solid tumours, autoimmune diseases, use of certain medicines and pregnancy. After treatment for bleeding complications, therapy focuses on restoring the coagulation time. The aim of immunomodulatory therapy is to stem production of autoantibodies against coagulation factor VIII. CONCLUSION AH must be considered rapidly in order to reduce the risk of bleeding emergencies and to screen for potential related diseases.
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Affiliation(s)
- A de Vitry
- Service de dermatologie, batiment Philippe-Canton, CHU, 6, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - A Valois
- Service de dermatologie, hôpital d'instruction des armées Legouest, 27, avenue de Plantières, 57070 Metz, France
| | - M Weinborn
- Service de dermatologie, batiment Philippe-Canton, CHU, 6, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - A-L Dupuy-de Fonclare
- Service de dermatologie, hôpital d'instruction des armées Legouest, 27, avenue de Plantières, 57070 Metz, France
| | - J-F Cuny
- Service de dermatologie, batiment Philippe-Canton, CHU, 6, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - A Barbaud
- Service de dermatologie, batiment Philippe-Canton, CHU, 6, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - J-L Schmutz
- Service de dermatologie, batiment Philippe-Canton, CHU, 6, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
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11
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Abstract
Acquired haemophilia A (AHA) is a rare but often severe bleeding disorder caused by autoantibodies against coagulation factor VIII (FVIII). AHA occurs more frequently in the elderly and in association with several conditions, such as the post-partum period, malignancies, autoimmune diseases or drug exposure; however, approximately 50% of reported cases are apparently idiopathic. Beside the elimination of the underlying disorder, the therapeutic approach to AHA should be directed toward the control of acute bleed and the eradication of FVIII autoantibody production. In this narrative review, we summarise the current knowledge on the epidemiology, diagnosis and clinical features of AHA, focusing in particular on advances in the management of this challenging bleeding disorder.
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Affiliation(s)
- Massimo Franchini
- Pier Mannuccio Mannucci, MD, Scientific Direction, IRCCS Cà Granda Foundation Maggiore Policlinico Hospital, Via Pace 9, 20122 Milan, Italy, Tel.: +39 02 5503 5414, Fax: +39 02 54 100 125, E-mail:
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12
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Hwang SH, Lim JA, Kim HC, Lee HW, Kim HS. Identification of a shared F8 mutation in the Korean patients with acquired hemophilia A. Korean J Hematol 2011; 46:49-51. [PMID: 21461305 PMCID: PMC3065628 DOI: 10.5045/kjh.2011.46.1.49] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 12/16/2010] [Accepted: 01/26/2011] [Indexed: 11/17/2022]
Abstract
Although uncommon, acquired hemophilia A (HA) is associated with a high rate of mortality due to severe bleeding. In spite of many hypotheses regarding the cause of acquired HA, there is as yet no established theory. In this study, we investigated the possibility that mutation(s) in the F8 gene may be correlated with the development of inhibitory autoantibodies. Direct sequencing analysis was performed on all 26 exons of the F8 gene of 2 patients exhibiting acquired HA. Both patients were found to share a common point mutation (c.8899G>A) in the 3'-untranslated region (3'-UTR) of exon 26. This is the first report on the genotyping of F8 in the context of acquired HA.
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Affiliation(s)
- Sung Ho Hwang
- Department of Biological Science, College of Natural Sciences, Ajou University, Suwon, Korea
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