title: Low-dose activated factor IX complex concentrates (FEIBA(R) ) for post-operative haemostasis in a patient with high responding factor VIII inhibitors.
abstract: Replacement therapy in patients with severe haemophilia A is associated with the development of inhibitory antibodies in about 15% [1,2]. The presence of inhibitors of factor VIII greatly complicates and compromises the treatment of these patients because of the lack of any completely satisfactory product to treat them. Haemostatic management for surgery in patients with inhibitors is very difficult. A product frequently used to treat bleeding episodes in such patients is prothrombin complex concentrate (PCC) [3] or its activated derivative (APCC) [4]. Activated recombinant human factor VII is another option [5]. For both these modalities of treatment, there are no laboratory tests that can be used to monitor clinical efficacy [5, 6]. Porcine factor VII is therefore the preferred product for surgery in patients with high-responding factor VIII inhibitors [7]. Unfortunately, none of these products are readily available in most developing countries, including India. We report the management of a patient with high-responding factor VIII inhibitor using low doses of FEIBA(R) (Immuno, Austria) in the post-operative period.
authors.affiliation: Departments of Haematology, Orthopaedics and Clinical Pathology CMC Hospital, Vellore, India.
authors.forename: A
authors.initials: A
authors.lastname: Bhave
authors.affiliation: Departments of Haematology, Orthopaedics and Clinical Pathology CMC Hospital, Vellore, India.
authors.forename: A
authors.initials: A
authors.lastname: Srivastava
authors.affiliation: Departments of Haematology, Orthopaedics and Clinical Pathology CMC Hospital, Vellore, India.
authors.forename: V
authors.initials: V
authors.lastname: Lee
authors.affiliation: Departments of Haematology, Orthopaedics and Clinical Pathology CMC Hospital, Vellore, India.
authors.forename: A J
authors.initials: AJ
authors.lastname: Daniel
authors.affiliation: Departments of Haematology, Orthopaedics and Clinical Pathology CMC Hospital, Vellore, India.
authors.forename: D
authors.initials: D
authors.lastname: Dennison
authors.affiliation: Departments of Haematology, Orthopaedics and Clinical Pathology CMC Hospital, Vellore, India.
authors.forename: G D
authors.initials: GD
authors.lastname: Sunderaj
authors.affiliation: Departments of Haematology, Orthopaedics and Clinical Pathology CMC Hospital, Vellore, India.
authors.forename: A
authors.initials: A
authors.lastname: Sudarsanam
keywords: Keywords:; factor IX complex concentrates; factor VIII inhibitors.; haemostasis