Management of perioperative bleeding in acquired hemophilia a secondary to melanoma: Case report

• Published in: JCA Advances 2024-12, Vol.1 (3-4), p.100049, Article 100049
• Main Authors: Medeiros, Heitor J.S., Gomes, Miguel Inácio Silva, de Morais, José Eustácio Aquino, Chaves, Diogo Barbalho, da Silva, Wallace Andrino
• Format: Article
• Language: English
• Subjects: Acquired hemophilia; Autoantibodies; Coagulation disorders; Immunosuppression; Melanoma
• ISSN: 2950-5534; 2950-5534
• DOI: 10.1016/j.jcadva.2024.100049

Acquired hemophilia A (AHA) is a rare hematological disorder caused by autoantibodies against factor VIII, leading to a high risk of bleeding. We report a case of a 74-year-old male with a history of melanoma who developed AHA, detected by prolonged activated partial thromboplastin time (aPTT) during preoperative testing for pulmonary metastasectomy. Despite no bleeding symptoms, tests confirmed the presence of factor VIII inhibitors. We managed the patient with factor VII concentrate and immunosuppressive therapy, including prednisone and rituximab. Postoperative monitoring revealed persistent inhibitor activity, requiring ongoing treatment. Melanoma likely contributed to immune system disruption, leading to AHA, though idiopathic causes cannot be excluded. This case highlights the need for thorough preoperative evaluation and tailored treatment in managing AHA, especially in cancer patients. The absence of prior PTT results limits our ability to assess baseline coagulation status. This report follows CARE guidelines for transparent case reporting.