[Prostate carcinoma associated spontaneous factor VIII:C inhibitor hemophilia. Successful therapy of severe hemorrhagic complication with porcine factor VIII in a 75-year-old patient].
Inhibitors of factor VIII are a rare condition in non-hemophiliacs, but they are frequently responsible for life threatening hemorrhage. Acquired factor VIII:C inhibitors represent the spontaneous development of autoantibodies that partially or completely neutralize the plasma coagulant activity of the clotting factor. The autoantibodies can arise in diverse clinical settings, in older adults they are frequently associated with immunologic disorders or malignancies. We report of a 75-year-old man with acquired factor VIII:C inhibitor associated with adenocarcinoma of the prostate and a successful treatment of a severe bleeding complication with porcine factor VIII. A 75-year-old man was admitted because of a hematoma of his right cheek and an isolated prolonged aPTT. Acquired factor VIII:C inhibitor was identified as the cause and immuno-suppressive therapy was begun. In the clinical course severe hemorrhaging occurred and was successfully treated with porcine factor VIII (Hyate:C). The initially high inhibitor titer of 32 Bethesda Units (BU) disappeared. As the cause of acquired factor VIII:C inhibitor a newly diagnosed adenocarcinoma of the prostate is likely. After complete remission of acquired factor VIII:C inhibitor radiation therapy was begun. Six months after severe hemorrhaging the patient was clinically stable and PSA levels were normal. This case demonstrates the necessity of a precise diagnosis and therapy regimen of this coagulopathy based on clinical and laboratory data. In the absence of hemorrhage immuno-suppressive therapy with corticosteroids is indicated, in a patient with severe bleeding and high inhibitor titer (> or = 5 BU) porcine factor VIII should be administered.
Orth
T
T
Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität Mainz.
Schnütgen
M
M
Herr
W
W
Mayet
W J
WJ
Dippold
W
W
Wanitschke
R
R
Meyer zum Buschenfelde
K H
KH
D000230:Adenocarcinoma / Q000276:immunology / Q000628:therapy*; D000368:Aged; D000818:Animals; D001780:Blood Coagulation Tests; D005169:Factor VIII / Q000037:antagonists & inhibitors* / Q000276:immunology / Q000627:therapeutic use; D006467:Hemophilia A / Q000276:immunology / Q000628:therapy*; D006801:Humans; D007518:Isoantibodies / Q000097:blood; D008297:Male; D010257:Paraneoplastic Syndromes / Q000276:immunology / Q000628:therapy*; D011471:Prostatic Neoplasms / Q000097:blood / Q000628:therapy*; D013552:Swine
D007518:Isoantibodies; D005169:Factor VIII