Researchers from San Joaquin General Hospital in California reported the case of a 66 year-old man who was simultaneously treated for acquired hemophilia A and prostate cancer.
“To our knowledge, this is the first reported case of prostate cancer diagnosed and treated simultaneously with acquired hemophilia A resulting in a favorable patient outcome,” Dr. Chirag Sheth and colleagues wrote.
The report, “Life-threatening hemorrhage from acquired hemophilia A as a presenting manifestation of prostate cancer,” was published in the Journal of Community Hospital Internal Medicine Perspectives.
The patient came to the hospital because of pain and swelling in his right thigh and an inability to walk for one month. He was diagnosed with hematoma (or abnormal collection of blood outside the blood vessels) in his right leg, which was removed by surgery.
However, following the operation, the patient started bleeding excessively and required an emergency blood transfusion.
On further analysis, researchers saw that the level of factor VIII inhibitors in his blood was very high and the factor VIII activity was less than 1 percent of normal. He was diagnosed with acquired factor VIII deficiency, also called acquired hemophilia A. It’s a very rare condition characterized by the acquisition of autoantibodies against factor VIII, an essential blood clotting protein, which leads to a predisposition to the formation of hematomas. The condition is associated with autoimmune diseases, pregnancy, giving birth, drugs, and cancer.
Once it was established that the patient had acquired hemophilia A, he was given drugs to block the production of factor VIII inhibitors.
Further investigations to determine the underlying cause of his condition revealed significantly high prostate-specific antigen in his blood, which led the scientists to diagnose him with locally advanced prostate cancer.
Based on his high risk of bleeding and his overall critical condition, the patient was given only hormonal therapy to treat the cancer.
After a 35-day period of hospitalization, and a two-day intervention against minor bleeding, the patient was discharged.
At the three months follow-up, no more bleeding episodes were recorded, there were no factor VIII inhibitors in his blood, and factor VIII activity was increased to 170 percent.
According to the researchers, “the patient continues to remain asymptomatic with regular follow-up in our outpatient hematology and oncology clinic.”
The authors concluded that this case demonstrates the importance of recording episodes such as sudden onset of bleeding in patients who had no prior personal or family history of similar bleeding episodes.
They said this patient’s case illustrates that simultaneous treatment of underlying cause (in this case prostate cancer) along with immunosuppressive therapy can result in a favorable outcome in acquired hemophilia A.
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