Protein A sepharose immunoadsorption: immunological and haemostatic effects in two cases of acquired haemophilia.
Acquired haemophilia is a life-threatening disorder caused by circulating auto-antibodies that inhibit factor VIII coagulant activity (FBIII:C). Immunoadsorption on protein A sepharose (IA-PA) was performed in two bleeding patients with acquired haemophilia: we observed a dramatic and quick decrease in the anti-FVIII:C inhibitor titre leading to a normal, albeit transient, haemostatic status. In one case, IA-PA was the only procedure which succeeded in stopping massive haemorrhage. In the second case, IA-PA reinforced the haemostatic effect of recombinant activated factor VII by increasing the endogenous plasma factor VIII level. The efficacy of IA-PA was sustained with immunosuppressive treatment introduced, respectively, 10 and 15 d before the IA-PA procedures. Our experience with IA-PA suggests that this extracorporeal anti-FVIII:C removal procedure is a valuable therapeutic tool for acquired haemophilia and can alleviate life-threatening haemorrhages.
Guillet
B
B
Laboratoire d'Hématologie et Centre de Référence et de Traitement de l'Hémophilie, Hôpital Bicêtre, AP-HP et Faculté de Médecine Paris XI, 94275 Le Kremlin-Bicêtre, Paris, France.
Kriaa
F
F
Huysse
M G
MG
Proulle
V
V
George
C
C
Tchernia
G
G
D'Oiron
R
R
Laurian
Y
Y
Charpentier
B
B
Lambert
T
T
Dreyfus
M
M
D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control; D015942:Factor VIIa / Q000627:therapeutic use; D006467:Hemophilia A / Q000276:immunology / Q000628:therapy*; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D007163:Immunosorbent Techniques; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000628:therapy; D010956:Plasmapheresis / Q000379:methods*; D011994:Recombinant Proteins / Q000627:therapeutic use; D013205:Staphylococcal Protein A
D007074:Immunoglobulin G; D011994:Recombinant Proteins; D013205:Staphylococcal Protein A; D015942:Factor VIIa