Extracorporeal immunoadsorption for the treatment of haemophilic patients with inhibitors to factor VIII or IX.
OBJECTIVE
This article reviews the relevance of immunoadsorption in the treatment of haemophilic patients with inhibitors.


METHODS
Immunosorba (sepharose-bound staphylococcal protein A) and Ig-Therasorb (sepharose-bound polyclonal sheep antibodies to human immunoglobulin) columns are suitable for the clinical use of immunoadsorption. They allow the processing of large plasma volumes (>7,000 ml) without relevant side-effects.


RESULTS
A haemophilic patient was treated with the Malmö protocol, another was admitted with intracerebral bleeding. Immunoadsorption reduced the inhibitor titer by 70-90%.


CONCLUSIONS
Immunoadsorption can be used in cases of acute bleeding, before surgery, acquired factor VIII (FVIII) antibodies, and before the start of immune tolerance therapy. We suggest the inclusion of this method in immune tolerance protocols in order to improve levels, recovery, and half-life of FVIII and to save concentrates.
Knöbl
P
P
Department of Medicine 1, Division of Haematology and Haemostaseology, University of Vienna, Austria. Paul.Knoebl@akh-wien.ac.at
Derfler
K
K
D002846:Chromatography, Affinity; D005112:Extracorporeal Circulation / Q000379:methods; D005164:Factor IX / Q000037:antagonists & inhibitors* / Q000276:immunology; D005169:Factor VIII / Q000037:antagonists & inhibitors* / Q000276:immunology; D006467:Hemophilia A / Q000097:blood / Q000276:immunology / Q000628:therapy*; D006801:Humans; D007108:Immune Tolerance; D007163:Immunosorbent Techniques; D007518:Isoantibodies / Q000097:blood / Q000302:isolation & purification
D007518:Isoantibodies; D005169:Factor VIII; D005164:Factor IX