The coexistence of von Willebrand disease and hemophilia A with inhibitors is extremely rare and presents significant treatment challenges due to combined defects in primary and secondary hemostasis. We report the case of a 55-year-old male with severe, refractory rectal bleeding caused by angiodysplasia, identified as a late complication of pelvic radiotherapy for prostate cancer. Standard replacement therapies were ineffective due to high-titer inhibitors against both factor VIII and von Willebrand factor. Surgical formation of a colostomy failed to stop the bleeding. A multidisciplinary team—including a hematologist, gastroenterologist, dental and hematology nurses, and a transfusion specialist—opted for endoscopic application of autologous plasma rich in growth factors (PRGF) gel. The gel was prepared from the patient’s own blood and applied locally to bleeding sites via colonoscopy. A total of seven applications were performed at two-week intervals. The therapy achieved local hemostasis, promoted mucosal healing, and led to a marked reduction in bleeding and stabilization of the patient’s condition. This case required close coordination between departments to ensure timely blood collection, gel preparation, and application.  Nursing care was intensive, focusing on preventing complications from prolonged immobilization, maintaining nutrition, and supporting overall recovery. The patient was hospitalized for six months and categorized as high-risk based on Braden and Morse scales. Despite the complexity of the case, he was discharged with preserved functionality and no recurrent bleeding. This report underscores the potential of PRGF gel as an innovative therapeutic option in complex bleeding disorders and highlights the critical role of a multidisciplinary approach when standard treatments fail.

Bozana Rakusic, MScN, is a nurse specialist with extensive experience in hematology, currently serving as a shift leader at the Department for Thrombosis, Hemostasis, and Benign Hematological Diseases, University Hospital Centre Zagreb. She holds both a bachelor’s and master’s degree in nursing from University North in Varazdin, with a focus on management and team leadership.Over nearly a decade of clinical practice, Bozana has developed advanced skills in the assessment and monitoring of hematological patients, patient and family education, and the coordination of multidisciplinary care. She has contributed as an author and co-author to several scientific publications and presentations at national and international congresses, and is actively involved in clinical research studies. Bozana is a dedicated member of the Croatian Network of Hematology Nurses and Technicians and the Croatian Hemophilia Society. She is recognized for her strong communication and organizational abilities, professional approach, and empathetic care for patients. Through continuous professional development and volunteer activities, Bozana is committed to improving the quality of healthcare and advancing the nursing profession in Croatia.