Clinical Consults™: A Challenging Case of Acquired Hemophilia A in a Patient with a Malignancy

This activity has expired.
Release Date: June 8, 2018
Expiration Date: June 8, 2019
Estimated Time to Complete Activity: 30 minutes
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Target Audience
This activity has been designed to meet the educational needs of hematologists, oncologists, hematology/oncologists, emergency physicians, registered nurses, advanced practice registered nurses, pharmacists, and other specialists in the hemophilia treatment center team, as well as other healthcare providers interested in the management of bleeding complications in patients with acquired hemophilia.

Statement of Need/Program Overview
Acquired hemophilia A (AHA) is a rare but serious etiology of severe bleeding caused by spontaneous formation of neutralizing antibodies (inhibitors) to coagulation factor VIII. The reported mortality rate ranges from 6% to 22% and is in part attributable to delays in diagnosis and appropriate treatment due to a general lack of familiarity with this condition. Because of its rarity, knowledge of AHA and the ability to perform trials to inform management are limited. AHA is rarely suspected, and there is a great need to raise awareness so that those seeing these patients first can act appropriately. If AHA is suspected, immediate consultation with a hematologist or coagulation specialist can improve patient outcomes.

Cancer and its treatment can be underlying etiologies of AHA, yet there is a general lack of awareness and knowledge of this condition among oncologists. Persistence of factor VIII (FVIII) autoantibodies in a patient with cancer may complicate necessary invasive diagnostic or therapeutic procedures, or even lead to lethal hemorrhage in the long term. Oncologists must maintain a high index of suspicion for AHA as one potential cause of bleeding in patients with a malignancy. 

Educational Objectives
After participating in this activity, the participant should be better able to:

  • Recognize the clinical signs and symptoms indicative of AHA in the context of malignancies
  • Perform laboratory testing to confirm or eliminate AHA etiology of bleeding
  • Administer appropriate agents to control acute bleeding
  • Develop individualized strategies for FVIII inhibitor eradication in patients with a malignancy

Planning Committee and Presenting Faculty

Miguel A. Escobar, MD
Miguel A. Escobar, MD
Department of Pediatrics and Internal Medicine
Division of Hematology
Professor, University of Texas
Health Science Center at Houston
McGovern Medical School
MD Anderson Cancer Center
Medical Director, Gulf States Hemophilia and
Thrombophilia Center
Houston, Texas

Julie Rowe, MD
Julie Rowe, MD
Assistant Professor, Oncology
McGovern Medical School at
The University of Texas Health Science Center at Houston
Division of Oncology, Department of Internal Medicine
Houston, Texas

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and Educational Concepts in Medicine. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education
The Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.5 contact hours. Designated for 0.2 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.

ASCLS P.A.C.E. ® Credits
Postgraduate Institute for Medicine is approved as a provider of continuing education programs in the clinical laboratory sciences by the ASCLS P.A.C.E. ® Program.  This program is approved for up to 0.50 ASCLS P.A.C.E.® contact hours.

Method of Participation
During the period of June 8, 2018, through June 8, 2019, participants must:

  • Read the learning objectives and faculty disclosures
  • Study the educational activity
  • Complete the posttest by recording the best answer to each question
  • Complete the evaluation form

A statement of credit will be issued automatically upon successful completion of the post-activity survey with a score of 75% or better and submitting the activity evaluation.

Fee Information
There is no fee for this educational activity.

Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high-quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Name of Faculty or Presenter Reported Financial Relationship
Miguel A. Escobar, MD Consulting Fees: Bayer, CSL Behring, Genentech, HEMA Biologics, National Hemophilia Foundation, Novo Nordisk, Shire.
Julie Rowe, MD I have no real or apparent conflicts of interest to report.

The planners and managers the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Name of Planner or Manager Reported Financial Relationship
PIM Clinical Reviewers: Trace Hutchison, PharmD; Samantha Mattiucci, PharmD, CHCP; Judi Smelker-Mitchek, RN, BSN; Jan Schultz, RN, MSN, CHCP Have no real or apparent conflicts of interest to report.
ECM: Patrick J. Crowley, MBA, Managing Partner/CEO; Jodi Andrews, BS, Partner/COO; Helen Morfit, BA, Program Director; Christine H. Blood, PhD, Medical Writer Have no real or apparent conflicts of interest to report.

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. 

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

This educational activity is supported by an independent medical educational grant from Shire.

This activity is jointly provided by: