RAREACQUIREDBLEEDINGDISORDERS

Abstract

Accurate diagnosis of the cause of bleeding is a prerequisite for determination of the optimal therapeutic response. Clinicians are generally aware of the more prevalent hemorrhagic syndromes but some rare acquired conditions are also of importance. In many of these, inhibitors of coagulation factors or of platelet adhesion/aggregation cause bleeding. These inhibitors are generally, but not always, immunoglobulins. In this review, the less common inhibitors of coagulation and hemostasis, as well as some important but rare nutritional, iatrogenic and disease associated hemorrhagic disorders, are described.

Acquired haemophilia as a paraneoplastic manifestation of pancreatic cancer

“…The two main lines of therapy are the haemostatic therapy for the haemorrhage and immunotherapy in order to eradicate the antibodies [8]. At most centres, the first-line therapy usually includes the recombinant factor VII or activated prothrombin complex concentrate is used until the bleeding is controlled [13]. Steroids alone or in combination with cyclophosphamide has also been a recommended first-line therapy.…”

The Laboratory Approach to Inherited and Acquired Coagulation Factor Deficiencies

“…In contrast to the rare inherited deficiencies, coagulation factor deficiencies are acquired commonly. 16 These include deficiencies secondary to autoantibody formation leading to neutralization of factor activity or rarely, accelerated clearance from the circulation. 17 Other acquired causes include decreased production (eg, liver disease), impaired synthesis (eg, vitamin K deficiency), and increased destruction (disseminated intravascular coagulation and thrombolytic therapy).…”

A critical appraisal of the use of recombinant factor VIIa in acquired bleeding conditions

“…Acquired haemophilia is a rare but potentially life‐threatening condition. Acquired antibodies are most commonly directed against factor VIII but may also be directed against the other coagulation factors (Watson et al , 2001).…”