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Case Reports
. 2018 Nov 26;6(14):781-785.
doi: 10.12998/wjcc.v6.i14.781.

Acquired hemophilia A in solid cancer: Two case reports and review of the literature

Makoto Saito  1 , Reiki Ogasawara  2 , Koh Izumiyama  2 , Akio Mori  2 , Takeshi Kondo  2 , Masanori Tanaka  2 , Masanobu Morioka  2 , Masahiro Ieko  3
Affiliations
Case Reports

Acquired hemophilia A in solid cancer: Two case reports and review of the literature

Makoto Saito et al. World J Clin Cases. .

Abstract

Acquired hemophilia A (AHA) is a rare, hemorrhagic autoimmune disease, whose pathogenesis involves reduced coagulation factor VIII (FVIII) activity related to the appearance of inhibitors against FVIII. Common etiological factors include autoimmune diseases, malignancy, and pregnancy. We report two cases of AHA in solid cancer. The first case is a 63-year-old man who developed peritoneal and intestinal bleeding after gastrectomy for gastric cancer. He was diagnosed with AHA, and was treated with prednisone, followed by cyclophosphamide. In the second case, a 68-year-old man developed a subcutaneous hemorrhage. He was diagnosed with AHA in hepatocellular carcinoma on CT imaging, and treated with rituximab alone. Hemostasis was achieved for both patients without bypassing agents as the amount of inhibitors was reduced and eradicated. However, both patients died within 1 year due to cancer progression. Successful treatment for AHA in solid cancer can be difficult because treatment of the underlying malignancy is also required.

Keywords: Acquired hemophilia A; Case report; Coagulation factor VIII; Gastric cancer; Hepatocellular carcinoma; Solid cancer.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Clinical course in case 1. RBC-Tf: Red blood cell transfusion; Hb: Hemoglobin; APTT: Activated partial thromboplastin time; PSL: Prednisone; CPA: Cyclophosphamide; TS1: Tegafur/gimeracil/oteracil.
Figure 2
Figure 2
Esophagogastroduodenoscopy imaging (Case 1). Intestinal bleeding was detected from the site of anastomosis.
Figure 3
Figure 3
Abdominal computed tomography imaging (Case 2). HCC (5.5 cm in diameter) was noted in segment 7 of the liver.
See this image and copyright information in PMC

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