Aspirin unmasking acquired haemophilia A in a patient with prostate cancer

Abstract

A 72-year-old man, on treatment for prostate cancer, attended the emergency department with his 2nd episode of spontaneous extensive bruising and haematomas. His first presentation was 2 months prior but this was thought to be because of his aspirin and he improved when aspirin was discontinued. On this occasion aspirin had been restarted 7 days before he developed his symptoms. His blood investigation was significant for a much raised activated partial thromboplastin time (aPTT). On his 3rd day of admission he deteriorated clinically with a drastic drop in his haemoglobin and worsening tense haematomas. Blood investigations confirmed the diagnosis of acquired factor VIII deficiency and he subsequently received treatment with factor VIII inhibitor bypassing activity, steroids and immunosuppresants.

Case – Acquired hemophilia A in a patient with metastatic castration-resistant prostate cancer

“…There are numerous causes of abnormal bleeding in the cancer patient, and this case was complicated by long term steroid use, aspirin 8 , and recent commencement of chemotherapy which initially was considered as a potential cause of the development of AHA. As in this case, patients with AHA often present with spontaneous mucosal bleeding, hematomas, or hematuria, and contrary to inherited hemophilia, hemarthrosis is rare 9 .…”

Bismuth Subsalicylate Coagulopathy in a Patient with Chronic Liver Disease

“…Coagulopathy has been reported in patients using salicylate and relevant publications are summarized in the supplemental table, which provides a summary of eight case reports and two case series [10][11][12][13][14][15][16][17][18]. All cases had eventual resolution of coagulopathy before either being discharged from the hospital or expiring.…”

“…Note that several of the reported cases involved salicylate-related coagulopathy in patients with normal hepatic function. One other published case involved bismuth subsalicylate [12], six publications involved acetylsalicylic acid [ 10,11,14,[16][17][18], and two publications involved methyl salicylate [13,15].…”