Shwaiki A, Lara L, Ahmed F, Crock R, Rutecki G W, Whittier F C
Northeastern Ohio Universities College of Medicine (NEOUCOM), Affiliated Hospitals at Canton, 1320 Mercy Drive, NW, Canton, Ohio 44708, USA.
Ann Hematol. 2001 Feb;80(2):124-6. doi: 10.1007/s002770000246.
Acquired hemophilia (antibodies or inhibitors to factor VIII) is the most common acquired disease affecting clotting factors. It has been described in association with autoimmune disease, malignancy, dermatologic disorders, in the postpartum period, and with drug interactions. Factor VIII inhibitors have been previously described with lung cancer, three with squamous cell and one with adenocarcinoma. A 54-year-old woman presented with weight loss and shoulder pain. A chest X-ray revealed a right hilar mass, confirmed by computed tomography (CT) scan and biopsy revealed small cell lung cancer. Coagulation panel prior to bronchoscopy showed an increased partial thromboplastin time (aPTT). The presence of factor VIII inhibitor was demonstrated at 5 Bethesda units. The patient was treated with fresh frozen plasma twice for hemorrhagic episodes, and six cycles of chemotherapy were begun with carboplatin and etoposide 16. Eight months after the diagnosis, her aPTT was normal and the factor VIII inhibitor titer was undetectable. This is the first case report of small cell lung cancer and acquired hemophilia. A causal relationship between the malignancy and the presence of factor VIII inhibitors is suggested by the response to therapy.
获得性血友病（针对凝血因子 VIII 的抗体或抑制物）是影响凝血因子的最常见获得性疾病。它已被描述与自身免疫性疾病、恶性肿瘤、皮肤病、产后时期以及药物相互作用有关。先前已有关于肺癌伴发 VIII 因子抑制物的报道，其中 3 例为鳞状细胞癌，1 例为腺癌。一名 54 岁女性因体重减轻和肩部疼痛就诊。胸部 X 光显示右肺门肿块，计算机断层扫描（CT）扫描确诊，活检显示为小细胞肺癌。支气管镜检查前的凝血检查显示部分凝血活酶时间（aPTT）延长。VIII 因子抑制物水平为 5 贝塞斯达单位。患者因出血发作接受了两次新鲜冰冻血浆治疗，并开始使用卡铂和依托泊苷进行六个周期的化疗。诊断后八个月，她的 aPTT 恢复正常，VIII 因子抑制物滴度检测不到。这是首例小细胞肺癌伴发获得性血友病的病例报告。治疗反应提示恶性肿瘤与 VIII 因子抑制物的存在之间存在因果关系。
