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.
Keywords:
GI bleeding; haematology (incl blood transfusion); lung cancer (oncology).
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MeSH terms
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Abdomen
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Adrenal Gland Neoplasms / complications
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Adrenal Gland Neoplasms / diagnosis*
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Adrenal Gland Neoplasms / drug therapy
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Adrenal Gland Neoplasms / secondary
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Anemia / diagnosis
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Anemia / etiology
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Antineoplastic Agents / therapeutic use
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Autoantibodies / immunology
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Coagulants / therapeutic use
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Erythrocyte Transfusion
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Factor VIII / immunology
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Factor VIII / therapeutic use
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Factor VIIa / therapeutic use
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Female
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Gastrointestinal Hemorrhage / diagnosis*
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Gastrointestinal Hemorrhage / etiology
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Hemophilia A / diagnosis*
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Hemophilia A / etiology
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Hemophilia A / immunology
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Hemophilia A / therapy
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Humans
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Immunosuppressive Agents / therapeutic use
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Lung Neoplasms / complications
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Lung Neoplasms / diagnosis*
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Lung Neoplasms / pathology
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Lymphadenopathy
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Mediastinum
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Middle Aged
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Paraneoplastic Syndromes / diagnosis*
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Paraneoplastic Syndromes / etiology
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Paraneoplastic Syndromes / immunology
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Paraneoplastic Syndromes / therapy
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Small Cell Lung Carcinoma / complications
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Small Cell Lung Carcinoma / diagnosis*
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Small Cell Lung Carcinoma / drug therapy
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Small Cell Lung Carcinoma / secondary
Substances
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Antineoplastic Agents
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Autoantibodies
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Coagulants
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Immunosuppressive Agents
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Factor VIII
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Factor VIIa
Supplementary concepts
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Factor 8 deficiency, acquired