Chronic myeloid leukaemia in a haemophiliac

Acute myelogenous leukemia in a patient with severe factor IX deficiency

We present a case of acute myelogenous leukemia in a patient with severe hemophilia and our approach to the prevention of bleeding complications during chemotherapy. In the few reports of acute leukemia occurring in patients with hemophilia, management of bleeding has mostly consisted of replacement of factor and platelets on demand. By prophylactically treating our patient with Factor IX at 50% correction three times per week and maintaining his platelet count above 30 × 10(3)/mm(3), bleeding complications were avoided. However, due to the rarity of this combination, it is difficult to draw a best practice recommendation.

Malignancy in patients with haemophilia: a review of the literature

Haemophilia A and B are rare X-linked conditions. Elevated rates of HIV and hepatitis C related malignancies in these patients are well reported, however rates of other types of cancers are not. Therefore, a retrospective literature review of cancer in patients with haemophilia was conducted. A Medline search of articles from January 1966 to July 2009 utilizing the keywords haemophilia, leukaemia, malignancy, mortality, neoplasm and cancer was performed. The articles were reviewed and additional relevant publications were located from the references. Data on age, type and severity of haemophilia, HIV status, type of malignancy and outcomes were recorded as available. Thirty-two cases of leukaemia were identified as well as 159 malignant solid tumours. Specific incidence and prevalence rates could not be calculated due to the limited nature of the information available in the reports. Many types of malignancy have been reported in persons with haemophilia irrespective of infection with HIV and hepatitis C yet prevalence and incidence rates compared to the general population remain unknown. Patients with haemophilia can manifest non infectious related malignancies and symptomatic patients should be evaluated accordingly.