PB0001 - Management of acquired haemophilia A in a Portuguese Center: 16 years and 16 cases

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Cristina Catarino, Dr

Doctor
Centro Hospitalar Universitário Lisboa Norte
Lisboa, Lisboa, Portugal

Co-Author(s)

FR

Fátima Rodrigues

Doctor
Centro Hospitalar Universitário Lisboa Norte
Lisboa, Lisboa, Portugal
AP

Artur Pereira

Doctor
Centro Hospitalar Universitário Lisboa Norte
Lisboa, Lisboa, Portugal
JP

Joana S. Pestana

Resident
Evora
Evora, Evora, Portugal
Carolina Peixoto, MD

Doctor
Centro Hospitalar Universitário Lisboa Norte
Lisboa, Lisboa, Portugal
SC

Soraia Campaniço

Medical Doctor
Centro Hospitalar Universitário Lisboa Norte - Hospital Santa Maria, Lisbon, Portugal
Lisboa, Lisboa, Portugal
LP

Liubov Parusnikova

Medical Doctor
Centro Hospitalar Universitário Lisboa Norte - Hospital Santa Maria, Lisbon, Portugal
Lisboa, Lisboa, Portugal
CJ

Catarina J. Jacinto

Doctor
Centro Hospitalar Universitário Lisboa Norte
Lisboa, Lisboa, Portugal
CP

Carla Pereira

Attending Doctor of Immunohemotherapy
Centro Hospitalar Universitário Lisboa Norte - Hospital Santa Maria, Lisbon, Portugal
Lisboa, Lisboa, Portugal
EP

Eunice Parcelas

Attending Doctor of Immunohemotherapy
Centro Hospitalar Lisboa Ocidental, Hospital de São Francisco Xavier, Lisboa
Lisboa, Lisboa, Portugal
JL

Joana Lucas

Medical Doctor
Hospital Nélio Mendonça
Funchal, Madeira, Portugal
DP

Dúlio Passos

Medical Doctor
Centro Hospitalar Universitário Lisboa Norte - Hospital Santa Maria
Lisboa, Lisboa, Portugal
SC

Sara Croca

Medical Doctor
Centro Hospitalar Universitário Lisboa Norte - Hospital Santa Maria
Lisboa, Lisboa, Portugal
PA

Patrícia Afonso

Pharmaceutic
Centro Hospitalar Universitário Lisboa Norte
Lisboa, Lisboa, Portugal
PM

Paulo Morgado

Laboratory Technician of Clinical Pathology
Centro Hospitalar Universitário Lisboa Norte - Hospital Santa Maria
Lisboa, Lisboa, Portugal
CC

Carina Calisto

Laboratory Technician of Clinical Pathology
Centro Hospitalar Universitário Lisboa Norte - Hospital Santa Maria
Lisboa, Lisboa, Portugal
SC

Sónia Cruz

Laboratory Technician of Clinical Pathology
Centro Hospitalar Universitário Lisboa Norte - Hospital Santa Maria
Lisboa, Lisboa, Portugal
MC

Maria Fátima Carriço

Medical Doctor of Clinical Pathology
Centro Hospitalar Universitário Lisboa Norte - Hospital Santa Maria
Lisboa, Lisboa, Portugal

Background: Management of acquired haemophilia A (AHA), a rare and severe autoimmune disease, is based in the control of bleeding, eradication of inhibitors and diagnosis of the underlying cause.

Aims: We, retrospectively, analyzed demographics, time for diagnosis and for eradication of inhibitors, symptoms, haemostatic and immunosuppressive therapy, prognosis, and underlying cause.

Methods: Between 2006 and 2021, 16 patients (9 males; 7 females), median age 76 years (62-90) were diagnosed at our Center.

Results: Time from onset of symptoms to diagnosis was less than 1 week in 7 patients, between 1 and 4 weeks in 5 and more than 4 weeks in 3.
Median FVIII was 3,5% ( < 1-21) and median higher inhibitor titer was 193 BU (3 -1250).
Symptoms observed were muscular (11); subcutaneous (3); oropharyngeal (2); urinary (3); intracranial (1) and gastrointestinal (1). In 3 patients bleeding was related to surgical procedures.
Hemostatic therapy was needed in 13 patients. Recombinant activated factor VII (rFVIIa) alone was effective in 9 /12 patients. In 1 patient, with a life-threatening hemorrhage, association with activated prothrombin complexes (aPCC) was needed. aPCC alone was effective in another patient. No adverse events related to haemostatic treatment were observed. Eight patients (50%) received other blood components.
In 10/11 patients who fully recovered, immunosuppression was done with corticoids only. In one patient, due to the severity of bleeding, cyclophosphamide and rituximab were associated with good results. Median time to remission was 26 days and no relapse was observed.
AHA was classified as idiopathic in 11/16 (62,5%) patients. In the other cases, AHA was related to Epstein- Barr virus (1); malignancy (2) and autoimmune disease (2). Mortality was observed in 5/ 16 patients, being bleeding the cause of death in 3 patients.

Conclusion(s): Diagnosis, treatment and prognosis of AHA is influenced by the timing of diagnosis and adequate and effective treatment.