Anti-inhibitor coagulant complex for the rescue therapy of acquired inhibitors to factor VIII: case report and review of the literature.
A 62-year-old African-American man with a history of hypertension, asthma, and prostate cancer, but no prior history of haemophilia presented with gross haematuria following a motor vehicle accident. Coagulation studies revealed a prolonged partial thromboplastin time. Subsequent mixing study and factor analysis confirmed factor VIII (FVIII) deficiency. The patient subsequently developed a knee haemarthrosis associated with persistent haematuria and a profoundly elevated FVIII inhibitor titre. Fresh frozen plasma was initiated upon presentation. Once FVIII inhibitor was discovered, immunosuppressive agents were started. Concurrent treatment with acute bypass agents including porcine FVIII, and recombinant human factor VIIa (rFVIIa;NovoSeven), was also given. Ultimately, anti-inhibitor coagulant complex (Autoplex T) was administered, stabilizing the haematuria and haemarthrosis. There was no additional bleeding 6 months after the last dose of anti-inhibitor coagulant complex. This case is consistent with others in which anti-inhibitor coagulant complex therapy was used successfully to manage patients with serious acute bleeding problems who are found to have acquired inhibitors to factor VIII.
Rush North Shore Medical Center, Department of Internal Medicine, North Shore Cancer Research Association, Skokie, IL, USA.
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Kleinman
D000063:Accidents, Traffic; D000208:Acute Disease; D001323:Autoantibodies / Q000276:immunology*; D019774:Blood Coagulation Factor Inhibitors / Q000097:blood*; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D005169:Factor VIII / Q000008:administration & dosage / Q000037:antagonists & inhibitors* / Q000276:immunology; D006417:Hematuria / Q000188:drug therapy* / Q000276:immunology; D006467:Hemophilia A / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000008:administration & dosage
D001323:Autoantibodies; D019774:Blood Coagulation Factor Inhibitors; D001779:Blood Coagulation Factors; D007166:Immunosuppressive Agents; D011994:Recombinant Proteins; C025667:prothrombin complex concentrates; C078147:F8 protein, human; D005169:Factor VIII; D011241:Prednisone