{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:10:17Z","timestamp":1756278617406,"version":"3.44.0"},"reference-count":12,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,12,23]]},"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:p>Around the world, with the availability of factor concentrates, patients with haemophilia have undergone major and minor surgeries. Inhibitor development in early postoperative period leading to inadequate factor recovery and ongoing bleeding is a nightmare for both operating surgeon as well as haematologists. We describe a case of an elderly man with mild haemophilia A, who was diagnosed with pancreatic carcinoma and underwent Whipple\u2019s procedure. After an uneventful procedure, he developed high-titre inhibitors and bleeding a week after surgery posing major challenges in his management. The case highlights the importance of experienced surgeons, trained haematologists, regular monitoring of factor assay\/inhibitors, adequate factor and bypassing-agent support while performing such procedures.<\/jats:p>","DOI":"10.1136\/bcr-2020-239207","type":"journal-article","created":{"date-parts":[[2021,1,29]],"date-time":"2021-01-29T11:17:34Z","timestamp":1611919054000},"page":"e239207","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Inhibitor development in mild haemophilia after a major surgery for periampullary cancer (Whipple\u2019s procedure) in an elderly man"],"prefix":"10.1136","volume":"14","author":[{"given":"Neha","family":"Ganju","sequence":"first","affiliation":[{"name":"Department of Hematology, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jayapal","family":"Rajendran","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery and Liver Transplant, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mukul","family":"Aggarwal","sequence":"additional","affiliation":[{"name":"Department of Hematology, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nihar","family":"Dash","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery and Liver Transplant, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,1,29]]},"reference":[{"key":"2025082623554209000_14.1.e239207.1","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1055\/s-0037-1615061","article-title":"Factor VIII inhibitors in mild and moderate-severity haemophilia a","volume":"79","author":"CRM","year":"1998","journal-title":"Thromb Haemost"},{"key":"2025082623554209000_14.1.e239207.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2516.2010.02231.x"},{"key":"2025082623554209000_14.1.e239207.3","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2516.2003.00780.x"},{"key":"2025082623554209000_14.1.e239207.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2009.03357.x"},{"key":"2025082623554209000_14.1.e239207.5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2010.04013.x"},{"key":"2025082623554209000_14.1.e239207.6","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2516.2002.00626.x"},{"key":"2025082623554209000_14.1.e239207.7","first-page":"1601","article-title":"Pancreaticoduodenectomy for pancreatic head cancer: PPPD versus Whipple procedure","volume":"52","author":"Lin","year":"2005","journal-title":"Hepatogastroenterology"},{"key":"2025082623554209000_14.1.e239207.8","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1111\/j.1365-2516.2006.01365.x","article-title":"Characteristics of inhibitors in mild\/moderate haemophilia a","volume":"12","author":"Peerlinck","year":"2006","journal-title":"Haemophilia"},{"key":"2025082623554209000_14.1.e239207.9","doi-asserted-by":"publisher","DOI":"10.1046\/j.1538-7836.2003.00230.x"},{"key":"2025082623554209000_14.1.e239207.10","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1111\/j.1365-2141.2012.09119.x","article-title":"Inhibitor incidence after intensive FVIII replacement for surgery in mild and moderate haemophilia A: a prospective national study in the Netherlands","volume":"157","author":"Eckhardt","year":"2012","journal-title":"Br J Haematol"},{"key":"2025082623554209000_14.1.e239207.11","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2516.2002.00687.x"},{"key":"2025082623554209000_14.1.e239207.12","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1136\/pmj.76.898.494","article-title":"General surgery in haemophiliac patients","volume":"76","author":"Bastounis","year":"2000","journal-title":"Postgrad Med J"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-239207","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T06:55:46Z","timestamp":1756277746000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-239207"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1,29]]},"published-print":{"date-parts":[[2021,1]]}},"alternative-id":["10.1136\/bcr-2020-239207"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-239207","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,1]]}}}