Acquired factor VIII inhibitor associated with prostatic cancer: successful treatment with steroid and immunosuppressive therapy.
Factor VIII inhibitors are antibodies of the IgG class that block functional epitopes or antigenic sites of factor VIII. They occur in about 5-20% of hemophilia A patients after infusions of factor VIII concentrate. Antibodies to factor VIII can also arise spontaneously in association with various autoimmune and chronic inflammatory diseases, hematologic malignancies, solid tumors, certain drugs, dermatologic conditions, and in puerperium. In the majority of cases, the clinical course is characterized by severe hemorrhages. Strategies to treat such inhibitors are controversial. We present the case of a patient with prostatic cancer who developed acquired factor VIII inhibitor. His severe bleeding complications were treated successfully with cyclophosphamide in combination with methylprednisolone. Within a few months, moreover, the immunosuppressive therapy brought about complete disappearance of the inhibitor and normalization of coagulation parameters. Our case illustrates that, although the clinical course in patients with acquired factor VIII inhibitor is not predictable, and the inhibitor may disappear spontaneously, combined therapy with cyclophosphamide and methylprednisolone should be considered for patients with severe hemorrhages.
II Divisione di Medicina Generale, Azienda Ospedaliera, Universitarie Convenzionate di Genova.
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Moccia
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Tognoni
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Boccaccio
D001778:Blood Coagulation Disorders / Q000188:drug therapy* / Q000209:etiology* / Q000276:immunology; D003520:Cyclophosphamide / Q000627:therapeutic use*; D005169:Factor VIII / Q000037:antagonists & inhibitors* / Q000276:immunology; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D007165:Immunosuppression Therapy; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000150:complications*
D005938:Glucocorticoids; D007074:Immunoglobulin G; D003520:Cyclophosphamide; D005169:Factor VIII; D008775:Methylprednisolone