Acquired haemophilia as a complicating factor in treatment of non-muscle invasive bladder cancer: A case report

Table 1 Coagulation parameters and factor VIII inhibitor values over time in a patient with acquired haemophilia

Parameter (physiological range)	Hospital admission (October 2019)	Acquired haemophilia diagnosed (December 11, 2019)	Treatment start (cyclophosphamide + prednisone)	Clinical and laboratory remission (December 2019)	Laboratory relapse (rituximab, February 2020)	Last TURBT (June 2020)
APTT-R (0.8-1.2)	1.71	2.42	2.38	0.98	1.2	0.81
FVIII (50%-150%)	-	2%	0.8%	81.6%	32%	206%
Inhibitor FVIII (0.0-0.8 BU/L)	-	-	33 BU/L	0.8 BU/L	1.0 BU/L	0.3 BU/L
Haemoglobin (120-160 g/L)	118 g/L	87 g/L	86 g/L	113 g/L	113 g/L	138 g/L
Platelets (150-400) × 109/L	293 × 109/L	291 × 109/L	403 × 109/L	366 × 109/L	340 × 109/L	318 × 109/L
INR	1.0	1.04	0.87	0.88	0.93	0.93
Bleeding symptoms	-	Haematuria	Haematuria	-	-	-

INR: International normalized ratio; TURBT: Transurethral resection of bladder tumour.

Table 2 Comparison of the present case to previously reported cases of acquired haemophilia associated with bladder cancer

Parameter (physiological range)	Case 1[3]	Case 2[2]	Case 3[11]	Presented case
	Bladder cancer. Sepsis. Rectal cancer	Bladder cancer. Sepsis	Bladder cancer. Lung mass. Lupus anticoagulant	Bladder cancer
FVIII (50%-150%)	≤ 1%	1%		2%
Inhibitor FVIII (0.0-0.8 BU/L)	64 BU/L	57 BU/L	250 BU/L	33 BU/L
Bleeding symptoms	Hematothorax. Subcutaneous haematoma	Intramuscular haematoma. Subcutaneous haematoma	Intramuscular haematoma. Subcutaneous haematoma	Haematuria
Therapy	Cyclophosphamide and prednisone	Cyclophosphamide and prednisone. Rituximab	Cyclophosphamide and prednisone. Rituximab	Cyclophosphamide and prednisone. Rituximab