Therapy of coagulation factor VIII autoantibodies with long-term extracorporeal protein A adsorption and immunosuppression.
Acquired factor VIII (FVIII) inhibitors in non-haemophiliacs may pose serious treatment problems.


METHODS
For IgG-adsorptions we utilized an automated plasma separation device and a plasma flow monitor.


METHODS
A 63-year old woman showed life-threatening bleeding because of an inhibitor. After stabilization by porcine FVIII three cycles of a modified Malmoe treatment protocol were applied, followed by long-term cyclophosphamide p.o. and weekly IgG-adsorptions. Within twelve months the patient exhibited a complete remission. A 54-year old man presented a comparable history. Because of a good response after the first cycle he was subsequently switched to the long-term therapy. Up to now (> 7 months) FVIII activities and inhibitor titers remained stable (10-20% rsp. < 3 BU/ml). In both cases no FVIII substitution therapy was necessary.


CONCLUSIONS
A modified Malmoe protocol combined with long-term cyclophosphamide p.o. and weekly IgG-adsorptions seems to be an efficient, safe and cost-effective regimen for non-haemophiliacs with FVIII inhibitors.
Taleghani
B M
BM
Department of Transfusion Medicine and Immunohematology, University of Wuerzburg, Germany.
Grossmann
R
R
Keller
F
F
Wiebecke
D
D
D001323:Autoantibodies / Q000302:isolation & purification*; D005169:Factor VIII / Q000276:immunology*; D005260:Female; D006801:Humans; D007163:Immunosorbent Techniques; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D013205:Staphylococcal Protein A; D013997:Time Factors