Successful treatment of a non‐haemophilic patient with inhibitor to factor VIII by double‐filtration plasmapheresis

Abstract

Summary. Factor VIII (FVIII) inhibitors appear in 3-20% of haemophilia A patients after injection of FVIII concentrates. However, autoantibodies to FVIII are also reported in nonhaemophiliacs. In these patients FVIII inhibitor disappears spontaneously or diminishes in response to immunosuppressive therapy. However, a few patients show resistance to immunosuppressive therapy. We describe a non-haemophilic elderly patient with acquired FVIII inhibitor who failed to respond to prednisolone. He was treated with doublefiltration plasmapheresis (DFPP) which resulted in a very rapid reduction in inhibitor levels and resolution of symptoms.

Acquired Haemophilia: Review and Meta‐Analysis Focused on Therapy and Prognostic Factors

“…Extracorporeal removal of the antibody may be indicated when a rapid reduction is needed, especially in cases of severe bleeding. Several methods have been used, such as plasmapheresis (Slocombe et al , 1981; Narukawa et al , 1999; Sunagawa et al , 1999) and immunoadsorption to staphylococcal protein A (Guillet et al , 2001) or polyclonal sheep antibodies against human immunoglobulins (Jansen et al , 2001). All these procedures have proved effective in this clinical setting but, with few exceptions (Toepfer et al , 1998; Ogata et al , 1999), they are always combined with immunosuppressive drugs, and their specific contribution is very difficult to assess.…”

Acquired factor VIII inhibitor presenting as a tongue hematoma

“…However, prednisolone alone or in combination with azathioprin is recommended for patients who have inhibitors associated with pregnancy because cyclophosphamide may cause infertility (8). Case reports of double-filtration plasmapheresis have reported success in treating patients with inhibitor refractory to immunosuppressive therapy (14).…”

Successful Treatment of Patients with Rheumatic Disorders and Acquired Factor VIII Inhibitors with Cyclophosphamide and Prednisolone Combination Therapy: Two Case Reports

“…Treatment with high-dose intravenous γ-globulin, 7 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (lomustine), 8 interferon 9 and double-filtration plasmapheresis 10 have also been reported. The most commonly used regimen, however, for patients with underlying autoimmune disorders in particular, consists of a combination of prednisolone and cyclophosphamide.…”