Acquired inhibitor to factor VIII in small cell lung cancer: a case report and review of the literature

Abstract

Acquired hemophilia (antibodies or inhibitors to factor VIII) is the most common acquired disease affecting clotting factors. It has been described in association with autoimmune disease, malignancy, dermatologic disorders, in the postpartum period, and with drug interactions. Factor VIII inhibitors have been previously described with lung cancer, three with squamous cell and one with adenocarcinoma. A 54-year-old woman presented with weight loss and shoulder pain. A chest X-ray revealed a right hilar mass, confirmed by computed tomography (CT) scan and biopsy revealed small cell lung cancer. Coagulation panel prior to bronchoscopy showed an increased partial thromboplastin time (aPTT). The presence of factor VIII inhibitor was demonstrated at 5 Bethesda units. The patient was treated with fresh frozen plasma twice for hemorrhagic episodes, and six cycles of chemotherapy were begun with carboplatin and etoposide 16. Eight months after the diagnosis, her aPTT was normal and the factor VIII inhibitor titer was undetectable. This is the first case report of small cell lung cancer and acquired hemophilia. A causal relationship between the malignancy and the presence of factor VIII inhibitors is suggested by the response to therapy.

Androgenic adult granulosa cell tumour with prolongation of the activated partial thromboplastin time in a 29 year old woman

“…Factor VIII inhibitors have been previously described in patients with lung cancer, liver cancer, prostate cancer and leukaemia 4–7 . Furthermore, factor IX, XI and XII inhibitors have been reported in colon cancer, chronic lymphocytic leukaemia, and gastric cancer, respectively 8–10 .…”

Postoperative paraneoplastic factor VIII auto‐antibodies in patients with solid tumours

“…As in most other immune-mediated paraneoplastic phenomena, the postoperative paraneoplastic FVIII antibodies are not specific for a certain type of cancer. However, they occurred predominantly after abdominal surgery (in particular for colon and pancreatic cancer), while no postoperative cases have been reported after surgery in lung and prostate cancers, which are both among the most common causes of paraneoplastic FVIII inhibitors [6,[23][24][25][26][27][28][29][30][31][32][33][34].…”

“…However, the mechanism of antibody formation is unknown in both conditions. Cases referenced in Hauser [5] and Sallah [6] and additional cases not cited in these reviews [23][24][25][26][27][28][29][30][31][32][33][34].…”

Akute Atemwegsverlegung durch erworbene Hämophilie A

“…Be gleit er kran kun gen as so zi iert, darun ter wa ren v. a. Ma lig no me (24) und rheu ma ti sche Er kran kun gen (16) auffäl lig. Der Um stand, dass die er wor be ne Hemm kör per hä mo phi lie bei ma lig nen Tumo ren, ins be son de re der Pros ta ta, Lun ge oder auch des Kopf-Hals-Be rei ches zu finden ist, lässt sich mög li cher wei se als eine Au toim mun re ak ti on ge gen den Tu mor aufgrund der Ähn lich keit zwi schen Tu mo ranti gen und dem Hemm kör per ge gen Fak tor VIII er klä ren [6,8,11].…”