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(22): 5338-5343 [PMID: 37621596 DOI: 10.12998/wjcc.v11.i22.5338]
Corresponding Author of This Article
Kateřina Ryšánková, MD, Doctor, Department of Urology, University Hospital Ostrava, Tr. 17. listopadu 1790, Ostrava 70852, Czech Republic. rysankovak@email.cz
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Aug 6, 2023; 11(22): 5338-5343 Published online Aug 6, 2023. doi: 10.12998/wjcc.v11.i22.5338
Acquired haemophilia as a complicating factor in treatment of non-muscle invasive bladder cancer: A case report
Kateřina Ryšánková, Jaromír Gumulec, Michal Grepl, Jan Krhut
Kateřina Ryšánková, Michal Grepl, Jan Krhut, Department of Urology, University Hospital Ostrava, Ostrava 70852, Czech Republic
Kateřina Ryšánková, Michal Grepl, Jan Krhut, 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
Jaromír Gumulec, Department of Internal Medicine, Faculty of Medicine, Ostrava University, Ostrava 70300, Czech Republic
Author contributions: Ryšánková K, Grepl M, and Krhut J contributed to the concept and design of this manuscript; Ryšánková K and Gumulec J were involved in the data acquisition; Ryšánková K, Grepl M, and Krhut J wrote the manuscript; Gumulec J and Krhut J edited the manuscript; and all authors approved the final of manuscript.
Supported byconceptual development of research organization, Ministry of Health, Czech Republic, No. FNOs/2023.
Informed consent statement: The patient gave her consent to publication of this data. All treatments administered were according to respective professional guidelines.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kateřina Ryšánková, MD, Doctor, Department of Urology, University Hospital Ostrava, Tr. 17. listopadu 1790, Ostrava 70852, Czech Republic. rysankovak@email.cz
Received: March 30, 2023 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
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.
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.
