title: Factor VIII and IX deficiencies related to acquired inhibitors in a patient with chronic hepatitis C virus infection receiving treatment with pegylated interferon plus ribavirin.
abstract: The development of clotting factor inhibitor autoantibodies is rarely observed, but can result in a potentially life-threatening haemorrhagic disorder. These acquired inhibitors are most frequently against factor VIII (FVIII), whilst the detection of inhibitors against other clotting factors is rarer. Inhibitors against FVIII and FIX are mostly observed in patients with classical hereditary haemophilia after receiving factor replacement therapy. We report a rare case of acquired FVIII and factor IX (FIX) inhibitors in a single, non-haemophilic patient with chronic hepatitis C virus (HCV) infection who was receiving antiviral treatment with pegylated interferon plus ribavirin. The FVIII and FIX activities were <1% and high titres of inhibitors autoantibodies were found in his serum samples. After achieving a sustained virological response, combined immunosuppression with oral corticosteroids (prednisone) and azathioprine was introduced, eradicating the inhibitory autoantibodies. The development of these inhibitors in association with antiviral therapy for chronic hepatitis C is poorly understood, and particular attention must be given to HCV-infected patients with worsening coagulopathy, particularly if coexistent with treatment related thrombocytopenia.
authors.affiliation: Hematology Unit - Medical Clinic 'B', Gaffrée & Guinle University Hospital, School of Medicine and Surgery, Federal University of the State of Rio de Janeiro, Brazil.
authors.forename: Marilza
authors.initials: M
authors.lastname: Campos-de-Magalhães
authors.forename: Carlos
authors.initials: C
authors.lastname: Eduardo Brandão-Mello
authors.forename: Maria
authors.initials: M
authors.lastname: Lúcia Elias Pires
authors.forename: Maria
authors.initials: M
authors.lastname: Cecília da Fonseca Salgado
authors.forename: Selma
authors.initials: S
authors.lastname: Barcelo de Brito
authors.forename: Adilson
authors.initials: A
authors.lastname: José de Almeida
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001323:Autoantibodies / Q000097:blood*; D004359:Drug Therapy, Combination; D005164:Factor IX / Q000276:immunology; D005169:Factor VIII / Q000276:immunology; D006467:Hemophilia A / Q000209:etiology; D002836:Hemophilia B / Q000209:etiology*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000009:adverse effects* / Q000627:therapeutic use; D011994:Recombinant Proteins; D012254:Ribavirin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D001323:Autoantibodies; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; D005169:Factor VIII; D005164:Factor IX; C417083:peginterferon alfa-2b