Case 35 – update 2

We have diagnosed our patient with acquired haemophilia A. They have also had a CT scan which is highly suspicious of a caecal cancer. Given the acquired haemophilia it was felt unsafe to proceed with invasive investigations for the caecal area over concerns regarding achieving haemostasis while the factor 8 was at it’s initial low level with the inhibitor.

The patient presented with a right thigh intramuscular bleed and was started on FEIBA and prednisolone. The patient had treatment with FEIBA for 12 days and the haematoma has settled. They are now mobilising with the physio.
Around day 12 the factor 8 inhibitor level had significantly reduced, and it was felt that the safest thing from a patient bleeding point of view was to hold off colonoscopy for a further week.
After 3 weeks of treatment with prednisolone the factor VIII inhibitor was undetectable and the factor VIII level had risen to 105%.
A colonoscopy was performed and the histology had shown an adenocarcinoma of the colon.
Close liaison was kept with histopathologist and surgeons as to not delay definitive treatment for this patients.
The surgical team have reviewed the patient and feel the patient requires surgery to remove the tumour, which from imaging does not appear to have metastasised.
Thankfully in our case prednisolone alone has worked swiftly to eradicate the factor VIII inhibitor. What other treatment options could we have used if this did not work? Would you have done anything differently?

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