Autopsy and Case Reports
Autopsy and Case Reports
Article / Clinical Case Report

Acquired hemophilia A in a patient with advanced prostate cancer

Daniel da Motta Girardi; Douglas Rafael Almeida Silva; Paula Ribeiro Villaça; Ciro Eduardo Souza; Leonardo Gomes da Fonseca; Diogo Assed Bastos; Paulo Marcelo Gehm Hoff

Downloads: 7
Views: 349


Acquired hemophilia A (AHA) is a rare disorder that results from the presence of autoantibodies against the clotting factor VIII (FVIII) causing hemorrhagic disorders. This entity is mostly associated with autoimmune diseases, pregnancy, the postpartum period, drugs and malignancy. Among the solid cancers, prostate neoplasm is the most common cause of AHA. The management of AHA involves the control of active bleeding and the use of specific therapies to eliminate the inhibitor. The authors describe the case of an 87-year-old man with prostate cancer who developed a bleeding disorder 5 years after the cancer diagnosis. Treatment with prednisone did not reach a satisfactory clinical response, which was only achieved with the association of azathioprine. The patient became asymptomatic with no further bleeding episodes, but developed a fatal sepsis after 3 months of treatment with these immunosuppressive agents.


Factor 8 deficiency, acquired, Prostatic Neoplasm, Hemorrhage


Franchini M, Gandini G, Di Paolantonio T, Mariani G. Acquired hemophilia A: a concise review. Am J Hematol. 2005;80(1):55-63. 10.1002/ajh.20390.16138334

Knoebl P, Marco P, Baudo F, et al. Demographic and clinical data in acquired hemophilia A: results from the European Acquired Haemophilia Registry (EACH2). J Thromb Haemost. 2012;10(4):622-31. 10.1111/j.1538-7836.2012.04654.x.22321904

Sallah S, Wan JY. Inhibitors against factor VIII in patients with cancer. Analysis of 41 patients. Cancer. 2001;91(6):1067-74. 10.1002/1097-0142(20010315)91:6<1067::AID-CNCR1101>3.0.CO;2-4.11267950

Reeves BN, Key NS. Acquired hemophilia in malignancy. Thromb Res. 2012;129(Suppl 1):S66-8. 10.1016/S0049-3848(12)70019-1.22682137

Bitting RL, Bent S, Li Y, Kohlwes J. The prognosis and treatment of acquired hemophilia: a systematic review and meta-analysis. Blood Coagul Fibrinolysis. 2009;20(7):517-23. 10.1097/MBC.0b013e32832ca388.19644360

Shetty S, Bhave M, Ghosh K. Acquired hemophilia a: diagnosis, aetiology, clinical spectrum and treatment options. Autoimmun Rev. 2011;10(6):311-6. 10.1016/j.autrev.2010.11.005.21115138

Collins PW, Hirsch S, Baglin TP, et al. Acquired hemophilia A in the United Kingdom: a 2-year national surveillance study by the United Kingdom Haemophilia Centre Doctors’ Organisation. Blood. 2007;109(5):1870-7. 10.1182/blood-2006-06-029850.17047148

Delgado J, Jimenez-Yuste V, Hernandez-Navarro F, Villar A. Acquired haemophilia: review and meta-analysis focused on therapy and prognostic factors. Br J Haematol. 2003;121(1):21-35. 10.1046/j.1365-2141.2003.04162.x.12670328

Franchini M, Targher G, Montagnana M, Lippi G. Laboratory, clinical and therapeutic aspects of acquired hemophilia A. Clin Chim Acta. 2008;395(1-2):14-8. 10.1016/j.cca.2008.05.003.18505682

Hauser I, Lechner K. Solid tumors and factor VIII antibodies. Thromb Haemost. 1999;82(3):1005-7.10494753

Huth-Kühne A, Baudo F, Collins P, et al. International recommendations on the diagnosis and treatment of patients with acquired hemophilia A. Haematologica. 2009;94(4):566-75. 10.3324/haematol.2008.001743.19336751

W Collins P, Chalmers E, Hart D, et al. Diagnosis and management of acquired coagulation inhibitors: a guideline from UKHCDO. Br J Haematol. 2013;162(6):758-73. 10.1111/bjh.12463.23889317

Baudo F, Collins P, Huth-Kühne A, et al. Management of bleeding in acquired hemophilia A: results from the European Acquired Haemophilia (EACH2) Registry. Blood. 2012;120(1):39-46. 10.1182/blood-2012-02-408930.22618709

Collins P, Baudo F, Knoebl P, et al. Immunosuppression for acquired hemophilia A: results from the European Acquired Haemophilia Registry (EACH2). Blood. 2012;120(1):47-55. 10.1182/blood-2012-02-409185.22517903


Publication date:

569538fa64cc8b1a57053d87 autopsy Articles

Autops Case Rep

Share this page
Page Sections