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Paraneoplastic acquired haemophilia A in extensive-stage small cell lung cancer (ES-SCLC) in the era of immunotherapy
  1. Mehrnoosh Pauls1,
  2. Natalia Rydz2,
  3. Nancy A Nixon3 and
  4. Doreen Ezeife4
  1. 1Medical Oncology, University of Ottawa, Ottawa, Canada
  2. 2Division of Hematology and Hematologic Malignancies, University of Calgary, Calgary, Canada
  3. 3Medicine, University of Calgary, Calgary, Canada
  4. 4Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Canada
  1. Correspondence to Dr Mehrnoosh Pauls; Mehrnoosh.pauls{at}gmail.com

Abstract

Small cell lung cancer (SCLC) is a deadly and rapidly progressive disease that can present with various paraneoplastic syndromes on initial workup. Acquired factor VIII (FVIII) deficiency, also known as acquired haemophilia A (AHA), has been identified as a rare paraneoplastic syndrome in SCLC. Here, we present a 61-year-old woman with a massive gastrointestinal bleed and prolonged activated partial thromboplastin time (PTT) in the emergency department. She was diagnosed with rare paraneoplastic AHA secondary to extensive-stage SCLC (ES-SCLC). She was treated with high-dose steroids and factor bypassing agents, which led to the resolution of bleeding and undetectable FVIII inhibitor levels. She was subsequently treated for ES-SCLC with carboplatin, etoposide and atezolizumab. This case report highlights a rare clinical presentation of paraneoplastic AHA that necessitates prompt recognition in patients with SCLC with ongoing bleeding and elevated PTT.

  • haematology (incl blood transfusion)
  • lung cancer (oncology)
  • GI bleeding

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Footnotes

  • Contributors MP: Contributed to planning, conduct and writing the case report. DE: Contributed to planning, helping with writing/editing the case report. NR and NAN: Contributed to writing/editing the case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.