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PLASTIC RECONSTRUCTIVE AND REGENERATIVE SURGERY

Abstract

Short description

Since the early 2000s, FVIII prophylaxis has been the standard for severe hemophilia A, but patients with inhibitors who failed immune tolerance induction (ITI) had no effective prophylaxis until emicizumab, which significantly reduced bleeding rates and improved quality of life. A 67-year-old man with severe hemophilia A and high-titer inhibitors, managed previously with bypassing agents, began emicizumab prophylaxis in 2021 and experienced over three years without bleeding, including safe dental procedures. In 2024, he was diagnosed with stage III pancreatic cancer, and despite emicizumab, he had multiple severe bleeding episodes during diagnostic and therapeutic procedures, requiring large doses of rFVIIa; bleeding ceased after stereotactic radiotherapy. This case highlights emicizumab’s transformative impact but also its limitations during major medical interventions, emphasizing the continued need for on-demand treatment and consideration of ITI even in the era of non-factor therapies.

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Authors

Mario Biglietto - Hematology, Department of Translational and Precision Medicine Sapienza University of Rome, Italy https://orcid.org/0000-0003-1487-5812

Silvia Linari - Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, Florence, Italy https://orcid.org/0000-0002-5849-7377

Anna Laura Faccini - Hematology, Department of Translational and Precision Medicine Sapienza University of Rome, Italy

Silvia Sorella - Hematology, Department of Translational and Precision Medicine Sapienza University of Rome, Italy https://orcid.org/0009-0009-6893-257X

Erica Crisanti - Hematology, Department of Translational and Precision Medicine Sapienza University of Rome, Italy https://orcid.org/0000-0002-9621-4841

Marco Antonacci - Hematology, Department of Translational and Precision Medicine Sapienza University of Rome, Italy https://orcid.org/0009-0000-0359-8755

Silvio Ligia - Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy https://orcid.org/0000-0002-2803-3766

Rosaria Mormile - Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy

Roberta Ciciani - Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy https://orcid.org/0009-0008-8590-2682

Erminia Baldacci - Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy https://orcid.org/0000-0002-1759-615X

Cristina Santoro - Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy https://orcid.org/0000-0002-7181-447X

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