Development of Acquired Hemophilia A After Treatment of Bronchial Asthma with Benralizumab
- PDF / 265,415 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 31 Downloads / 209 Views
CORRESPONDENCE
Development of Acquired Hemophilia A After Treatment of Bronchial Asthma with Benralizumab Hiroaki Kitamura1 • Yasushi Kubota2 • Rika Tomimasu1 • Haruki Hirakawa1 Hiroshi Inoue1 • Hitomi Umeguchi1 • Moeko Yoshida3 • Hideki Akahoshi3 • Shiho Tsuruda3 • Rie Ide3 • Shinya Kimura2 • Masaharu Miyahara1
•
Received: 4 September 2020 / Accepted: 13 October 2020 Ó Indian Society of Hematology and Blood Transfusion 2020
Dear Editor, Acquired hemophilia A (AHA) is caused by an immune response to factor VIII (FVIII); cells, cytokines, and other immune regulatory molecules play a role in formation of inhibitory anti-FVIII antibodies [1]. Here, we report the first case of AHA following treatment with benralizumab, an anti-IL-5 receptor alpha monoclonal antibody, in a patient with bronchial asthma (BA). A 71-year-old woman with BA was treated with benralizumab (30 mg via subcutaneous injection), which controlled the condition for 9 months. However, 2 months after the fifth dose of benralizumab she was referred to our hospital with hematuria and a prolonged activated partial thromboplastin time (aPTT). She had no family history of bleeding disorder. Physical examination was unremarkable. Laboratory examination revealed a markedly prolonged aPTT of 79.4 s (reference range 25–35 s). The platelet count and prothrombin time were normal. A mixing study identified inhibitors. There was a marked reduction in FVIII coagulant activity (1%), but factor IX coagulant activity and von Willebrand factor activity were normal. The inhibitor titer against FVIII was 25 Bethesda units/mL. The patient was negative for antinuclear antibodies, lupus anticoagulant, and anticardiolipin antibodies. Computed & Hiroaki Kitamura [email protected] 1
Department of Internal Medicine, Karatsu Red Cross Hospital, 2430 Watada, Karatsu 847-8588, Japan
2
Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
3
Department of Laboratory Medicine, Karatsu Red Cross Hospital, Karatsu, Japan
tomography (CT) imaging showed a high-density area in the left renal pelvis suggestive of bleeding; there was no clear evidence of a tumor. Cystoscopy demonstrated bleeding from the left ureteral orifice. No malignant cells were detected on urine cytology. A diagnosis of AHA was made, with benralizumab as a possible underlying cause. Therefore, benralizumab was discontinued and she received immediate immunosuppressive therapy with oral prednisone (0.75 mg/kg/day). Thereafter, hematuria improved and the aPTT and FVIII coagulant activity returned to normal on Days 43 and 64, respectively, posttreatment with prednisone. Anti-FVIII inhibitor levels fell gradually, and prednisone was slowly tapered off (Fig. 1). Disappearance of the high-density area in left renal pelvis was confirmed by CT imaging. In about half of cases, the cause of AHA is unknown; the remaining cases may be associated with underlying disease and drug treatments [2]. In the present case, aging was
Data Loading...
