Inhibitor development in mild haemophilia after a major surgery for periampullary cancer (Whipple's procedure) in an elderly man.

Abstract

Around the world, with the availability of factor concentrates, patients with haemophilia have undergone major and minor surgeries. Inhibitor development in early postoperative period leading to inadequate factor recovery and ongoing bleeding is a nightmare for both operating surgeon as well as haematologists. We describe a case of an elderly man with mild haemophilia A, who was diagnosed with pancreatic carcinoma and underwent Whipple's procedure. After an uneventful procedure, he developed high-titre inhibitors and bleeding a week after surgery posing major challenges in his management. The case highlights the importance of experienced surgeons, trained haematologists, regular monitoring of factor assay/inhibitors, adequate factor and bypassing-agent support while performing such procedures.

• Authors: Neha Ganju, Jayapal Rajendran, Mukul Aggarwal, Nihar Dash
• Journal: BMJ case reports (BMJ Case Rep) Vol. 14 Issue 1 (Jan 29 2021) ISSN: 1757-790X [Electronic] England
• PMID: 33514621 (Publication Type: Case Reports, Journal Article)
• Copyright: © BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Blood Coagulation Factors
• Immunoglobulin Fc Fragments
• Recombinant Fusion Proteins
• factor VIII-Fc fusion protein
• Factor VIII

Topics

• Aged
• Antibody Formation (immunology)
• Blood Coagulation Factors (antagonists & inhibitors, immunology)
• Factor VIII (administration & dosage, therapeutic use)
• Fatal Outcome
• Hematology (standards)
• Hemophilia A (complications, immunology)
• Humans
• Immunoglobulin Fc Fragments (administration & dosage, therapeutic use)
• Intracranial Hemorrhages (complications)
• Male
• Pancreatic Neoplasms (complications, surgery)
• Postoperative Complications (epidemiology, immunology)
• Postoperative Hemorrhage (drug therapy, etiology)
• Recombinant Fusion Proteins (administration & dosage, therapeutic use)
• Risk Factors
• Surgeons (statistics & numerical data)