Immunoadsorption of factor VIII inhibitors

Abstract

Although immunoadsorption was shown to be clinically effective in patients with inhibitors to factor VIII more than two decades ago, recent papers have emphasized the desirability of early implementation of the modality in the treatment plan. Immunoadsorption is relatively easy to perform with few adverse effects, but specialized equipment is required, and it should be performed in an experienced setting. Although potentially less costly than other (bypass) therapies, immunoadsorption is itself not inexpensive, and its comparative effectiveness with plasmapheresis and other management options for the dangerously bleeding patient with antibodies to factor VIII should be determined by multicenter randomized controlled trials. Interesting recent novel technical developments in the field may facilitate increased use of the procedure.

Immunoadsorption with single‐use columns for the management of bleeding in acquired hemophilia A: A series of nine cases

“…A strong argument in favor of single-use columns is that these are storable avoiding time losses due to shipping and at the same time affordable reducing financial loss when replacement is necessary due to expiration of the device. Additionally, since the exact characteristics of the responsible inhibitor in acquired hemophilia usually remain unknown in the clinical setting, IA modalities providing efficient and unspecific binding capacity for all IgG subclasses, IgM and IgA are preferable [13,14]. In inherited forms of hemophilia reusable systems based on staphylococcal protein A or anti-immunoglobulin columns are commonly used.…”

“…E-mail: brzoska@em.uni-frankfurt. de. episodes are reduced [12][13][14]. In contrast to inherited hemophilia eradication of the inhibitor in acquired hemophilia enables the patient to replenish the missing factor spontaneously, thus making IA a major treatment principle in this disease.…”

Acquired hemophilia in a patient with systemic lupus erythematosus: a case report and literature review

“…Since our patient showed relatively minor bleeding episodes without severe hemorrhage, we did not consider administration of coagulation factor concentrates. Elimination of the inhibitor is usually achieved through long-term immunosuppression of antibody formation with corticosteroids, cytotoxic agents, such as CY and CsA, or combination therapy, as well as IVIG therapy and/or plasmapheresis or immunoadsorption [6,[13][14][15][16][17]. Singleagent PSL has a reported response rate of approximately 30% in patients [13,18].…”

Intracellular Trafficking, Metabolism and Toxicity of Current Gene Carriers

“…Clinically, plasmapheresis, double filtration plasmapheresis and immunoabsorbant plasmapheresis have been attempted to remove the circulating neutralizing antibodies from blood prior to gene transfer to increase the transduction rates of target tissues [38,39]. PEGylation of genetherapy vectors have also proven to overcome the barrier of neutralizing antibodies even without plasmapheresis [40].…”