Zhao PW, Hu YS, Jiang Z, Ainiwaer M, Liu J, Chen F. Recurrent hemoptysis after laryngectomy-acquired hemophilia induced by laryngeal cancer surgery and chemoradiotherapy: A case report. World J Clin Cases 2025; 13(33): 112305 [PMID: 41356080 DOI: 10.12998/wjcc.v13.i33.112305]
Corresponding Author of This Article
Fei Chen, MD, PhD, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610048, Sichuan Province, China. hxchenfei@163.com
Research Domain of This Article
Oncology
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Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 26, 2025 (publication date) through Jan 9, 2026
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Publication Name
World Journal of Clinical Cases
ISSN
2307-8960
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Zhao PW, Hu YS, Jiang Z, Ainiwaer M, Liu J, Chen F. Recurrent hemoptysis after laryngectomy-acquired hemophilia induced by laryngeal cancer surgery and chemoradiotherapy: A case report. World J Clin Cases 2025; 13(33): 112305 [PMID: 41356080 DOI: 10.12998/wjcc.v13.i33.112305]
Peng-Wei Zhao, Yan-Sheng Hu, Zheng Jiang, Mailudan Ainiwaer, Jun Liu, Fei Chen, Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu 610048, Sichuan Province, China
Peng-Wei Zhao, Yan-Sheng Hu, Zheng Jiang, Mailudan Ainiwaer, Jun Liu, Fei Chen, Head and Neck Surgical Center, West China Hospital, Sichuan University, Chengdu 610048, Sichuan Province, China
Co-first authors: Peng-Wei Zhao and Yan-Sheng Hu.
Author contributions: Zhao PW and Hu YS contributed equally to this work, were responsible for conceptualization, data collection, and drafting the manuscript; Jiang Z and Ainiwaer M involved in patient management, data interpretation, and critical revision of the manuscript; Liu J contributed to the literature review and data analysis; Chen F supervised the study, provided critical feedback, and finalized the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest regarding the publication of this paper.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fei Chen, MD, PhD, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610048, Sichuan Province, China. hxchenfei@163.com
Received: July 29, 2025 Revised: September 3, 2025 Accepted: October 23, 2025 Published online: November 26, 2025 Processing time: 115 Days and 23.8 Hours
Abstract
BACKGROUND
Acquired hemophilia A (AHA) is a rare autoimmune bleeding disorder characterized by autoantibodies against coagulation factor VIII (FVIII), leading to spontaneous bleeding in patients without a personal or family history of bleeding disorders. While AHA has been reported in association with various cancers, this case represents, to our knowledge, the first reported instance of AHA following head and neck cancer surgery and subsequent chemoradiotherapy.
CASE SUMMARY
We present the case of a 65-year-old male with a history of hypopharyngeal squamous cell carcinoma (T4bN2cM0, AJCC 8th edition) who developed AHA after extensive surgical resection and chemoradiotherapy. He presented with recurrent hemoptysis and ecchymosis. Coagulation studies showed isolated prolonged activated partial thromboplastin time of 83.8 seconds that did not correct with mixing studies. FVIII activity was < 1%, and a Bethesda assay confirmed FVIII inhibitors with a titer of 18.4 Bethesda units. Hemostasis was initially achieved with tranexamic acid and batroxobin. Immunosuppression with prednisone and cyclophosphamide was started; due to gastrointestinal bleeding, rituximab was added. Treatment was later transitioned to azathioprine with prednisone, followed by tapering. FVIII activity recovered to 188.2%, and the patient remained in remission over six years without AHA or malignancy recurrence.
CONCLUSION
This case underscores vigilance for AHA after head and neck cancer therapy to enable prompt treatment.
Core Tip: We report a unique case of acquired hemophilia A, an autoimmune bleeding disorder due to factor VIII (FVIII) autoantibodies, occurring after head and neck cancer surgery and chemoradiotherapy—a previously unreported association. A 65-year-old male developed recurrent hemoptysis, diagnosed by prolonged activated partial thromboplastin time and high-titer FVIII inhibitors. Intensive immunosuppressive therapy achieved sustained six-year remission, demonstrating the critical role of timely diagnosis and aggressive management for this severe therapy-related complication.
