Published online Nov 26, 2018. doi: 10.12998/wjcc.v6.i14.781
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
Processing time: 102 Days and 21.4 Hours
60s two Japanese men with solid cancer [one is gastric cancer, the other is hepatocellular carcinoma (HCC)] had a marked bleeding tendency.
Progressed anemia due to severe hemorrhage, requiring blood transfusion.
Hemorrhagic disease, such as immune thrombocytopenia or disseminated intravascular coagulation.
In both patients, hemoglobin level reached < 7 g/dL, prolonged APTT of 94 s, and FVIII activity was reduced to 3.1%. The inhibitor titer was 7.59 and 57.1 BU/mL respectively, compatible with acquired hemophilia A (AHA). In the second patients, hepatitis C virus antibodies were positive and the levels of alpha-fetoprotein and protein induced by vitamin K absence-II were 1862 ng/mL and 210 mAU/mL, respectively.
Endoscopic examination in the first case revealed intestinal bleeding from the site of the anastomosis. Abdominal computed tomography scan in the second patients revealed HCC (5.5 cm in diameter).
In the first case, resected stomach and intraperitoneal cytology identified gastric cancer.
Immunological treatments (prednisone and cyclophosphamide in case 1, and rituximab alone in case 2) were administered instead of bypassing agents. Oral tegafur/gimeracil/oteracil was administered in case 1, and transcatheter arterial chemoembolization was performed in case 2.
Recently, a systematic review described a large number of AHA patients with cancer.
AHA patients with cancer are more likely to exhibit recurrent hemorrhage and are less likely to achieve a complete response with eradication of the neutralizing autoantibodies.
Besides hemostatic therapy and immunological treatments, successful treatment of AHA patients with cancer requires the concurrent treatment of the underlying malignancy.