Clinical challenge of managing patients with multiple myeloma and acquired hemophilia A with risk of both thrombosis and bleeding: a narrative review

Acquired hemophilia A (AHA) is a rare bleeding disorder, caused by the development of autoantibodies (inhibitor) against endogenous clotting factor VIII (FVIII). common clinical manifestation subcutaneous bleeding, but soft tissue hematomas and excessive post-operative hemorrhages may also occur. diagnosis AHA made in patients presenting with an isolated prolonged activated partial thromboplastin time without correction mixed plasma study, decreased FVIII activity. Multiple myeloma (MM) hematological malignancy terminally differentiated cells producing monoclonal protein (M protein). Although found as underlying disorder 6–18% cases, MM seems to be very cause AHA. associated increased risk thrombotic complications, while leads up 95% cases (although one third do not require hemostatic treatment) therefore management concomitant challenge. For control therapy AHA, by-passing agents prothrombin complex concentrate recombinant VII, well porcine VIII, are efficient. However, for inhibitor eradication, immunosuppressive treatment can beinsufficient, intensive myeloma-aimed required. Disease- therapy-related coagulation alterations carry both thrombosis complicating this group patients.