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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.
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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
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Valença IN, Bezerra RDS, de Oliveira LCO, Covas DT, Kashima S, Slavov SN. Deep viral metagenomics in patients with haemophilia receiving plasma-derived coagulation factor concentrates. Haemophilia 2021; 27:e645-e648. [PMID: 34313362 DOI: 10.1111/hae.14382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/07/2021] [Accepted: 07/15/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Ian Nunes Valença
- Faculty of Medicine of Ribeirão Preto, Blood Center of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Rafael Dos Santos Bezerra
- Faculty of Medicine of Ribeirão Preto, Blood Center of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | | | - Dimas Tadeu Covas
- Faculty of Medicine of Ribeirão Preto, Blood Center of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Simone Kashima
- Faculty of Medicine of Ribeirão Preto, Blood Center of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Svetoslav Nanev Slavov
- Faculty of Medicine of Ribeirão Preto, Blood Center of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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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
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Carmo RA, Martins ML, Chaves DG, Dezanet LNC. Prevalence and risk factors associated with hepatitis C among Brazilian male patients with haemophilia: A long-term follow-up. Haemophilia 2019; 25:447-455. [PMID: 30866172 DOI: 10.1111/hae.13728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/22/2018] [Accepted: 02/13/2019] [Indexed: 12/12/2022]
Abstract
People with haemophilia represent a population with a high prevalence of HCV infection due to the use of blood components and plasma-derived clotting factor concentrates before the introduction of viral-inactivating procedures (in the 1980s) and screening for HCV (in the 1990s). About 80% of HCV-infected patients have chronic HCV infection, and at least 20% develop end-stage liver disease. The aim of the study was to assess current anti-HCV positivity in a large cohort of Brazilian haemophilia patients and to determine associated factors with HCV exposure. The study retrospectively analysed medical records of all male haemophilia patients attended the main public referral blood centre in Belo Horizonte, Brazil, from January 1985 to January 2015. Sociodemographic, epidemiological and serological characteristics were collected of all participants tested for anti-HCV. Among 724 patients enrolled in the study, anti-HCV was positive in 259 resulting in a seroprevalence of 35.8% (95% CI: 32.3%-39.3%). Factors independently associated with previous exposure to HCV were as follows: age older than 30 years, moderate to severe haemophilia, detection of inhibitor at least once in lifetime and previous exposure to hepatitis B virus (HBV) infection or HIV infection. Otherwise, exclusive previous use of inactivated clotting factors resulted in a significant decrease in the chance of positivity for anti-HCV. At the end of cohort period, patients with positive anti-HCV had a 3-fold higher risk of death. This study showed that hepatitis C infection remains a critical problem for Brazilian haemophilia patients and reinforced the need to unify efforts to eradicate it.
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Kose M, Bakkaloglu OK, Amikishiyev S, Akpınar TS, Saracoglu B, Akcan T, Oktem M, Yenerel MN, Güler K, Tükek T. Acquired FVIII and FIX Inhibitors after Pregnancy: A Case Report. Acta Haematol 2016; 136:229-232. [PMID: 27701158 DOI: 10.1159/000445706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 03/22/2016] [Indexed: 11/19/2022]
Abstract
Acquired hemophilia is a relatively rare clinical presentation, and most cases present with acquired FVIII inhibitor. The co-occurrence of inhibitors to multiple coagulation factors is uncommon. These autoantibodies may induce spontaneous life-threatening bleeding in patients who have had no previous bleeding disorder. Herein, we present a patient with postpartum acquired FVIII and FIX inhibitors who developed intramuscular hematoma and hemothorax during follow-up. She was then treated with activated prothrombin complex concentrate and methylprednisolone.
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Affiliation(s)
- Murat Kose
- Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Doma SA, Hillarp A, Pajič T, Andoljšek D, Černelč P, Preldžnik Zupan I. Concurrent acquired inhibitors to factor VIII and IX, a laboratory artifact: a case report. Biochem Med (Zagreb) 2016; 26:279-84. [PMID: 27346976 PMCID: PMC4910271 DOI: 10.11613/bm.2016.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/21/2016] [Indexed: 11/23/2022] Open
Abstract
Acquired inhibitors to coagulation factors other than factor VIII are extremely rare. We describe a case of a 59-year-old woman with abnormal bleeding, diagnosed with concurrent inhibitor antibodies to factor VIII and IX by Bethesda testing. We demonstrate that anti-FVIII antibodies of a very high titre are capable of disturbing the aPTT-based Bethesda assay, resulting in falsely-positive antibodies to factor IX. The case also illustrates the usefulness of the immunological assay (ELISA) in complementing the inhibitor diagnosis.
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Affiliation(s)
- Saša Anžej Doma
- Department of Hematology, University Medical Centre Ljubljana, Slovenia
| | - Andreas Hillarp
- Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden ; at the time of the investigation working at the Coagulation laboratory of Malmö Centre for Thrombosis and Haemostasis, Skane University Hospital, Malmö, Sweden
| | - Tadej Pajič
- Department of Hematology, University Medical Centre Ljubljana, Slovenia
| | - Dušan Andoljšek
- Department of Hematology, University Medical Centre Ljubljana, Slovenia
| | - Peter Černelč
- Department of Hematology, University Medical Centre Ljubljana, Slovenia
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Symptomatic Acquired Haemophilia Due to Circulating Antibodies Against Both Factor VIII and IX in a Non-haemophiliac Patient. Indian J Hematol Blood Transfus 2014; 30:90-2. [PMID: 25332547 DOI: 10.1007/s12288-013-0270-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 05/09/2013] [Indexed: 10/26/2022] Open
Abstract
Acquired haemophilia is a very rare condition, occurring in less than 2 per million populations. This condition is caused commonly by acquired antibodies against factor VIII and rarely by antibodies against factor IX. Here we describe an extremely rare presentation of idiopathic acquired haemophilia in an otherwise healthy male patient, caused by simultaneous occurrence of circulating antibodies against both factor VIII and IX.
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Martínez Pascual C, Antón Ródenas G, Ortiz Sánchez ML, Pons Miñano JA. Hemofilia A adquirida secundaria al tratamiento con peginterferón α-2a en un paciente con hepatitis crónica por el virus C. Med Clin (Barc) 2013; 141:228-9. [DOI: 10.1016/j.medcli.2013.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 12/22/2012] [Accepted: 01/10/2013] [Indexed: 10/27/2022]
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Orman ES, Fried MW. Hepatitis C viral infection in patients with hemophilia and hemolytic disorders. Clin Liver Dis (Hoboken) 2012; 1:95-97. [PMID: 31186859 PMCID: PMC6499263 DOI: 10.1002/cld.42] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 05/18/2012] [Accepted: 05/27/2012] [Indexed: 02/04/2023] Open
Affiliation(s)
- Eric S. Orman
- UNC Liver Center, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michael W. Fried
- UNC Liver Center, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Kalro AK, Currie B, Szabo F. Acquired haemophilia A treated with Rituximab in a patient with prostatic melioidosis. Haemophilia 2012; 18:e74-5. [PMID: 22531026 DOI: 10.1111/j.1365-2516.2012.02800.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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