Acquired hemophilia A (AHA) is a rare disorder that results from the presence of autoantibodies against the clotting factor VIII (FVIII) causing hemorrhagic disorders. This entity is mostly associated with autoimmune diseases, pregnancy, the postpartum period, drugs and malignancy. Among the solid cancers, prostate neoplasm is the most common cause of AHA. The management of AHA involves the control of active bleeding and the use of specific therapies to eliminate the inhibitor. The authors describe the case of an 87-year-old man with prostate cancer who developed a bleeding disorder 5 years after the cancer diagnosis. Treatment with prednisone did not reach a satisfactory clinical response, which was only achieved with the association of azathioprine. The patient became asymptomatic with no further bleeding episodes, but developed a fatal sepsis after 3 months of treatment with these immunosuppressive agents.
KnoeblP, MarcoP, BaudoF, et al. Demographic and clinical data in acquired hemophilia A: results from the European Acquired Haemophilia Registry (EACH2). J Thromb Haemost. 2012;10(4):622-31. [https://doi.org/10.1111/j.1538-7836.2012.04654.x]. [PMID:22321904]
BittingRL, BentS, LiY, KohlwesJ. The prognosis and treatment of acquired hemophilia: a systematic review and meta-analysis. Blood Coagul Fibrinolysis. 2009;20(7):517-23. [https://doi.org/10.1097/MBC.0b013e32832ca388]. [PMID:19644360]
CollinsPW, HirschS, BaglinTP, et al. Acquired hemophilia A in the United Kingdom: a 2-year national surveillance study by the United Kingdom Haemophilia Centre Doctors’ Organisation. Blood. 2007;109(5):1870-7. [https://doi.org/10.1182/blood-2006-06-029850]. [PMID:17047148]
DelgadoJ, Jimenez-YusteV, Hernandez-NavarroF, VillarA. Acquired haemophilia: review and meta-analysis focused on therapy and prognostic factors. Br J Haematol. 2003;121(1):21-35. [https://doi.org/10.1046/j.1365-2141.2003.04162.x]. [PMID:12670328]
HauserI, LechnerK. Solid tumors and factor VIII antibodies. Thromb Haemost. 1999;82(3):1005-7. [PMID:10494753]
Huth-KühneA, BaudoF, CollinsP, et al. International recommendations on the diagnosis and treatment of patients with acquired hemophilia A. Haematologica. 2009;94(4):566-75. [https://doi.org/10.3324/haematol.2008.001743]. [PMID:19336751]
W CollinsP, ChalmersE, HartD, et al. Diagnosis and management of acquired coagulation inhibitors: a guideline from UKHCDO. Br J Haematol. 2013;162(6):758-73. [https://doi.org/10.1111/bjh.12463]. [PMID:23889317]
BaudoF, CollinsP, Huth-KühneA, et al. Management of bleeding in acquired hemophilia A: results from the European Acquired Haemophilia (EACH2) Registry. Blood. 2012;120(1):39-46. [https://doi.org/10.1182/blood-2012-02-408930]. [PMID:22618709]
CollinsP, BaudoF, KnoeblP, et al. Immunosuppression for acquired hemophilia A: results from the European Acquired Haemophilia Registry (EACH2). Blood. 2012;120(1):47-55. [https://doi.org/10.1182/blood-2012-02-409185]. [PMID:22517903]