Case 38-2008 -- A 58-Year-Old Man with Hemophilia, Hepatocellular Carcinoma, and Intractable Bleeding

doi:10.1056/NEJMcpc0807506

Volume 359:2587-2597		December 11, 2008		Number 24

Case 38-2008 — A 58-Year-Old Man with Hemophilia, Hepatocellular Carcinoma, and Intractable Bleeding

Walter H. Dzik, M.D., Michael Laposata, M.D., Ph.D., Martin Hertl, M.D., Warren S. Sandberg, M.D., Ph.D., Manjil Chatterji, M.D., and Joseph Misdraji, M.D.

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Presentation of Case

Dr. Abner Louissaint (Pathology): A 58-year-old man with hemophiliawas admitted to this hospital because of hepatitis C infection,hepatocellular carcinoma, and recurrent bleeding.

A diagnosis of hemophilia A (factor VIII deficiency) had beenmade in infancy. The hemophilia was manifested by multiple hemarthroses,was treated with multiple transfusions of blood products andclotting factors, and was complicated by hepatitis C infection(genotype 1a). Two years before admission, a liver biopsy revealedchronic hepatitis with a score of 3 for portal activity anda score of 2 for lobular activity, with bridging fibrosis andno cirrhosis. Eight months before admission, . . . [Full Text of this Article]

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From the Blood Transfusion Service (W.H.D.) and the Departments of Pathology (M.L., J.M.), Transplant Surgery (M.H.), Anesthesia and Critical Care (W.S.S.), and Radiology (M.C.), Massachusetts General Hospital; and the Departments of Pathology (W.H.D., J.M.), Surgery (M.H.), Anaesthesia (W.S.S.), and Radiology (M.C.), Harvard Medical School.