Background Acquired hemophilia A (AHA) is a rare acquired bleeding disorder occurred due to the formation of inhibitory antibodies neutralizing endogenous factor VIII. Main body About half the cases are idiopathic. Symptoms include severe and unexpected bleeding that could be life-threatening. High index of suspicion should be raised when unexplained subcutaneous or post-surgical bleeding with isolated prolonged APTT. Conclusions Acquired hemophilia A is a rare underdiagnosed underreported acquired hemostatic disorder that presents with sudden usually life-threatening bleeding; it is crucial to raise awareness and suspicion index of clinicians for early diagnosis and treatment to avoid morbidity and mortality.
Angiogenesis is essential for tumor growth and progression and is mediated by positive and negative regulators of vessel growth. Since angiogenic mediators found in patient's serum have been postulated to reflect the angiogenic potential of a malignant tumor, the angiogenic stimulators activity such as vascular endothelial growth factor (VEGF) and angiogenesis inhibitors such as endostatin have been evaluated in the serum of patients with colorectal caner (CRC) with and without liver metastases, in an attempt to study the prognostic value of the above parameters. The present work was conducted on thirty six patients with colorectal cancer and twelve control subjects. The patients' group included twenty localized colorectal cancer patients all of them had radical surgical resection. The second patients' group consisted of sixteen colorectal cancer patients with liver metastases. The serum endostatin and VEGF levels were significantly higher in the patients with colorectal cancer versus healthy controls. When compared according to tumor stage, the liver metastatic group had significantly higher levels of serum endostatin and VEGF versus the localized invasive group (without distant metastasis). Both groups of patients with localized invasive cancer and patients with liver metastasis had significantly higher mean serum endostatin and VEGF levels versus healthy controls. Serum endostatin and VEGF levels in localized invasive group decreased significantly after resection of the tumor. There was a significant positive correlation between preoperative endostatin and VEGF levels in all cancer patients. High preoperative VEGF and endostatin levels were strongly associated with the tumor size, tumor grade, lymph node metastases and subsequent recurrence. Significant positive correlation was, also, detected between endostatin levels and number as well as volume of hepatic metastases.The previous results denote that serum levels of endostatin, and VEGF were elevated and positively correlated in patients with CRC. The elevation was associated with the stage of CRC, greater disease burden and subsequent recurrence. Thus, elevation of serum levels of endostatin, and VEGF might be considered as indicators of tumor invasion and metastasis in the future. Thus, the present study demonstrates the prognostic utility of measuring angiogenic and antiangiogenic factors before resection of colorectal cancer.
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