A Case of Acquired Haemophilia A in a Patient with Chronic Myelomonocytic Leukaemia
2019
A 67-year-old male, with a known diagnosis of
myelodysplastic syndromeswith multilineage dysplasia (MDS-MLD) was admitted to our hospital with a primary complaint of subcutaneous bleeding in his left thigh. Laboratory data showed anaemia and prolongation of activated
partial thromboplastin time(85.8 s, normal range 24–39 s) without thrombocytopenia. Coagulation factor VIII (FVIII) activity was less than 1% (normal range 60–150%), and a FVIII inhibitor was identified and quantified at 166 BU/mL to indicate a diagnosis of acquired
haemophiliaA (AHA). A recent, but sustained circulating
monocytosis(>1 × 109/L) was observed, which combined with elevated numbers of neutrophil and monocytic cells in the marrow, suggested evolution of MDS-MLD to chronic
myelomonocyticleukaemia (CMML), coinciding with AHA. Further analysis revealed a karyotype of 46, XY, i(14) (
q10), which was the same abnormality previously identified in the patient. To treat bleeding caused by AHA, steroid and
activated prothrombin complex concentratewere administered.
Azacitidine(AZA) was used to treat CMML. During the clinical course, bleeding partially improved; however, subsequent acute myocardial infarction occurred on day 87. Worsening
bone marrow failurewas observed 4 months after the original admission, despite administration of AZA therapy, and the patient died due to bleeding from AHA. This case suggests that the evolution of MDS to CMML status can be associated with AHA conferring a bleeding tendency.
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