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Inhibitor development in mild haemophilia after a major surgery for periampullary cancer (Whipple’s procedure) in an elderly man
  1. Neha Ganju1,
  2. Jayapal Rajendran2,
  3. Mukul Aggarwal1 and
  4. Nihar Dash2
  1. 1Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
  2. 2Department of Gastrointestinal Surgery and Liver Transplant, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Mukul Aggarwal; mukulmamc{at}


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.

  • GI bleeding
  • haematology (incl blood transfusion)
  • pancreatic cancer
  • surgical oncology
  • congenital disorders

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  • Contributors NG and MA made the treatment plan for factor support during surgery. ND and JR did the surgery. NG and MA wrote the manuscript. It was edited by all the authors.

  • 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 Next of kin consent obtained.

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