Lewis Akeem, Joseph Joe, Pathak Nirmal, Baseri Babak, Luhrs Carol
Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA.
Department of Hematology and Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA.
SAGE Open Med Case Rep. 2020 Feb 16;8:2050313X20906743. doi: 10.1177/2050313X20906743. eCollection 2020.
Acquired hemophilia A or acquired factor VIII deficiency is a rare bleeding disorder due to the presence of autoantibodies to factor VIII. It has been associated with autoimmune conditions, certain medications, and malignancy. It has a high morbidity and mortality, and early diagnosis and treatment is critically important. Acquired hemophilia A usually manifests with soft tissue bleeding, such as epistaxis, genitourinary, or gastrointestinal bleeding and rarely with hemarthrosis. In this case report, we present the management of an uncommon case of acquired hemophilia A in a patient with metastatic prostate adenocarcinoma who presented with both hemarthrosis and soft tissue bleeding. Bleeding was controlled with recombinant factor VIIa, factor VIII bypassing agent, and immunosuppressive therapy with prednisone and rituximab. Chemotherapy with docetaxel was also promptly initiated to address the underlying condition and achieve long-term remission, which is currently ongoing for 10 months.
获得性血友病A或获得性因子VIII缺乏症是一种罕见的出血性疾病，病因是存在针对因子VIII的自身抗体。它与自身免疫性疾病、某些药物和恶性肿瘤有关。其发病率和死亡率很高，早期诊断和治疗至关重要。获得性血友病A通常表现为软组织出血，如鼻出血、泌尿生殖系统或胃肠道出血，很少出现关节积血。在本病例报告中，我们介绍了一名转移性前列腺腺癌患者罕见的获得性血友病A病例的治疗情况，该患者同时出现了关节积血和软组织出血。通过重组因子VIIa、因子VIII旁路制剂以及泼尼松和利妥昔单抗的免疫抑制疗法控制了出血。还迅速启动了多西他赛化疗以治疗潜在疾病并实现长期缓解，目前缓解状态已持续10个月。
