1
|
Ceglédi A, Bátai Á, Dolgos J, Fekete M, Gopcsa L, Király V, Lakatos G, Nagy G, Szemlaky Z, Várkonyi A, Vilimi B, Mikala G, Bodó I. Case Report: Effective management of adalimumab-induced acquired hemophilia A with the CyDRI protocol. Pathol Oncol Res 2024; 30:1611720. [PMID: 38846411 PMCID: PMC11153699 DOI: 10.3389/pore.2024.1611720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/09/2024] [Indexed: 06/09/2024]
Abstract
Introduction Acquired Hemophilia A (AHA) is a rare autoimmune disorder characterized by the emergence of inhibitors that specifically target coagulation Factor VIII, frequently resulting in severe bleeding episodes. Methods We conducted a retrospective analysis of the medical records of a 68-year-old male patient who presented with adalimumab-induced AHA. Results The patient received adalimumab, a tumor necrosis factor inhibitor antibody, as part of his treatment for rheumatoid arthritis. The patient's clinical journey, characterized by intense bleeding and coagulopathy, was effectively managed with the application of recombinant Factor VIIa (rFVIIa) and the CyDRi protocol. Discussion The case emphasizes the importance of prompt coagulation assessment in patients with bleeding symptoms receiving disease-modifying therapy for rheumatoid arthritis that includes adalimumab therapy, considering the rare yet life-threatening nature of AHA. Additionally, this report provides an extensive review of the existing literature on drug-induced AHA, with a special emphasis on cases linked to immunomodulatory medications. Through this two-pronged approach, our report aims to enhance understanding and awareness of this severe complication among healthcare providers, promoting timely diagnosis and intervention.
Collapse
Affiliation(s)
- Andrea Ceglédi
- Departments of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
- Department of Public Health, Semmelweis University, Budapest, Hungary
- Doctoral College, Health Sciences Program, Semmelweis University, Budapest, Hungary
| | - Árpád Bátai
- Szent György Fejér County University Hospital, Székesfehérvár, Hungary
| | - János Dolgos
- Departments of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Mónika Fekete
- Department of Public Health, Semmelweis University, Budapest, Hungary
| | - László Gopcsa
- Departments of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Viktória Király
- Departments of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Gergely Lakatos
- Departments of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - György Nagy
- Department of Rheumatology and Clinical Immunology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Hospital of the Hospitaller Order of Saint John of God, Budapest, Hungary
| | - Zsuzsanna Szemlaky
- Departments of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Andrea Várkonyi
- Departments of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Beáta Vilimi
- Departments of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Gábor Mikala
- Departments of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
- School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Imre Bodó
- Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, United States
| |
Collapse
|
2
|
Mingot-Castellano ME, García Candel F, Benítez Hidalgo O, Marco A, Navarro GAM, Pérez-Montes R, Donas GG, Canaro M, Paloma MJ, Asenjo B, Calle-Gordo VM, González NP, González RR, Caparrón Miranda IS, París LQ, Herrero S, Nuñez R. Activated Prothrombin Complex Concentrate to Treat Bleeding Events in Acquired Hemophilia A: Bahas Study. Eur J Haematol 2022; 109:686-695. [PMID: 36029160 DOI: 10.1111/ejh.13853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Activated prothrombin complex concentrate (aPCC) is a bypassing agent indicated to treat bleeds in patients with acquired hemophilia A (AHA). Nevertheless, its efficacy and safety in the real-world setting has not often been addressed. METHODS We report the experience of Spanish reference centers for coagulation disorders and from acquired haemophilia Spanish Registry (AHASR), from August 2012 to February 2021. Follow-up period of 30 days after aPCC withdrawal. RESULTS Thirty patients with a median age of 70 years old, suffering from 51 bleeds treated with aPCC were finally evaluated. As first line treatment, aPCC stopped bleed in 13 of 14 (92.9%) cases. aPCC as second line after recombinant factor VIIa failure, stopped bleeding in the all cases. In 17 patients aPCC was used far from initial bleed control as prophylaxis of rebleeding with 94% effectiveness. No thromboembolic episodes was communicated. One patient developed hypofibrinogenemia, which did not prevent aPCC from halting bleeding. No other serious adverse events possibly or probably associated with aPCC were reported. CONCLUSIONS this data support aPCC as haemostatic treatment in AHA with high effectiveness and excellent safety profile in acute bleeds and as extended use to prevent rebleedings, even in anging people with high cardiovascular risk. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- María Eva Mingot-Castellano
- Hematology Department, Hospital Universitario Virgen del Rocio, Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain.,Hematology Department, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | | | - Ana Marco
- Hematology Department, Hospital General de Alicante4, Alicante, Spain
| | | | | | - Gloria García Donas
- Hematology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Mariana Canaro
- Hematology Department, Hospital Son Espases, Palma de Mallorca, Spain
| | - María José Paloma
- Hematology Department, Hospital Universitario Virgen del Camino, Pamplona, Spain
| | - Beatríz Asenjo
- Hematology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | | | | | | | - Laura Quintana París
- Hematology Department, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Sonia Herrero
- Hematology Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Ramiro Nuñez
- Hematology Department, Hospital Universitario Virgen del Rocio, Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain
| |
Collapse
|
3
|
Martins ML, Chaves DG, da Silva-Malta MCF, Bolina-Santos E, Barbosa-Stancioli EF, Carmo RA. Hepatitis C and history of FVIII inhibitor development in a long-term cohort of Brazilian patients with haemophilia A. Haemophilia 2020; 26:e130-e133. [PMID: 32072732 DOI: 10.1111/hae.13944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/14/2020] [Accepted: 01/30/2020] [Indexed: 06/10/2023]
Affiliation(s)
| | | | | | - Eduarda Bolina-Santos
- Laboratório de Virologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Edel Figueiredo Barbosa-Stancioli
- Laboratório de Virologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | |
Collapse
|
4
|
Sosa R, Gailani D, Neff AT. Development of anti-factor XIII antibodies in a patient with hereditary factor XIII deficiency receiving therapy for chronic hepatitis C. Haemophilia 2014; 20:e429-32. [PMID: 25333572 DOI: 10.1111/hae.12537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2014] [Indexed: 11/30/2022]
Affiliation(s)
- R Sosa
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | |
Collapse
|
5
|
de Vitry A, Valois A, Weinborn M, Dupuy-de Fonclare AL, Cuny JF, Barbaud A, Schmutz JL. [Acquired haemophilia A: two cases]. Ann Dermatol Venereol 2014; 141:441-5. [PMID: 24951143 DOI: 10.1016/j.annder.2014.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/17/2014] [Accepted: 03/03/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Acquired haemophilia A (AH) is an uncommon bleeding disorder that presents as multiple, disseminated spontaneous subcutaneous bleeds. Diagnosis may be made on the basis of prolonged activated partial thromboplastin time (aPTT). The severity of the disease is associated with the low risk of haemoglobin levels and with potential links with other diseases. OBSERVATIONS Two men were hospitalized for extensive and spontaneous subcutaneous hematoma. In both cases, the International Normalized Ratio (INR) was normal, but aPTT was 3 times higher than normal. Autoantibodies against coagulation factor VIII confirmed the diagnosis of AH. The patients received immunomodulatory treatment. In one patient, diffuse large B-cell lymphoma was discovered one year after successful treatment of AH. DISCUSSION AH may be revealed by areas of bruising, subutaneous haematomas mimicking erythema nodosum, and muscle pain. APTT results alone can prompt the biologist to screen for factor VIII inhibitors. Aside from the risk of fatal bleeding, in half of all cases, the prognosis is determined by associated disorders such as blood dyscrasias, solid tumours, autoimmune diseases, use of certain medicines and pregnancy. After treatment for bleeding complications, therapy focuses on restoring the coagulation time. The aim of immunomodulatory therapy is to stem production of autoantibodies against coagulation factor VIII. CONCLUSION AH must be considered rapidly in order to reduce the risk of bleeding emergencies and to screen for potential related diseases.
Collapse
Affiliation(s)
- A de Vitry
- Service de dermatologie, batiment Philippe-Canton, CHU, 6, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - A Valois
- Service de dermatologie, hôpital d'instruction des armées Legouest, 27, avenue de Plantières, 57070 Metz, France
| | - M Weinborn
- Service de dermatologie, batiment Philippe-Canton, CHU, 6, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - A-L Dupuy-de Fonclare
- Service de dermatologie, hôpital d'instruction des armées Legouest, 27, avenue de Plantières, 57070 Metz, France
| | - J-F Cuny
- Service de dermatologie, batiment Philippe-Canton, CHU, 6, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - A Barbaud
- Service de dermatologie, batiment Philippe-Canton, CHU, 6, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - J-L Schmutz
- Service de dermatologie, batiment Philippe-Canton, CHU, 6, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| |
Collapse
|
6
|
|