Published online Aug 6, 2023. doi: 10.12998/wjcc.v11.i22.5338
Peer-review started: March 30, 2023
First decision: April 26, 2023
Revised: May 16, 2023
Accepted: June 26, 2023
Article in press: June 26, 2023
Published online: August 6, 2023
Processing time: 125 Days and 21.7 Hours
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.
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.
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.
Core Tip: Patients with acquired haemophilia A, even those who have never experienced any previous haemorrhagic event, are at high risk of severe life-threatening bleeding in case that they need surgery. It is a rare disease that is often overlooked in the differential diagnosis, resulting in a delay with the risk of life-threatening consequences. Therefore, it is essential to avoid underestimating of the isolated prolongation of the activated partial thromboplastin time or other altered coagulation parameters detected prior to surgery.