Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2018; 6(14): 781-785
Published online Nov 26, 2018. doi: 10.12998/wjcc.v6.i14.781
Acquired hemophilia A in solid cancer: Two case reports and review of the literature
Makoto Saito, Reiki Ogasawara, Koh Izumiyama, Akio Mori, Takeshi Kondo, Masanori Tanaka, Masanobu Morioka, Masahiro Ieko
Makoto Saito, Reiki Ogasawara, Koh Izumiyama, Akio Mori, Takeshi Kondo, Masanori Tanaka, Masanobu Morioka, Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Japan
Masahiro Ieko, Department of Internal Medicine, Health Sciences University of Hokkaido, Toubetsu 0610293, Japan
Author contributions: Saito M, Ogasawara R, Izumiyama K, Mori A, Kondo T, Tanaka M, Morioka M and Ieko M collected the patient’s clinical data; Saito M designed and wrote the report.
Informed consent statement: Consent was obtained from each patient or family (wife) for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest in this work.
CARE Checklist (2016) statement: I have prepared this report according to the guidelines of the CARE Checklist (2016).
Open-Access: 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/
Correspondence to: Makoto Saito, MD, PhD, Department of Internal Medicine and Hematology, Aiiku Hospital, Minami 4 Nishi 25 Chuo-ku, Sapporo 0640804, Hokkaido, Japan. ikyoku@aiiku-hp.or.jp
Telephone: +81-11-5632211
Received: August 20, 2018
Peer-review started: August 21, 2018
First decision: October 11, 2018
Revised: October 21, 2018
Accepted: October 22, 2018
Article in press: October 22, 2018
Published online: November 26, 2018
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, Coagulation factor VIII, Solid cancer, Gastric cancer, Hepatocellular carcinoma, Case report

Core tip: Acquired hemophilia A (AHA) is a rare hemorrhagic disease usually affecting the elderly, involving reduced coagulation factor VIII activity. Malignancies are reported to occur in association with 10%-15% of patients with AHA. We report two cases of AHA in solid cancer, namely, gastric cancer and hepatocellular carcinoma. Hemostasis was fully achieved owing to eradication of inhibitor against factor VIII, however, both patients died within 1 year due to cancer progression. Successful treatment for AHA in solid cancer can be difficult because not only active hemorrhage management and inhibitor eradication but also treatment of the underlying malignancy is required.