Treatment of coagulation inhibitors with extracorporeal immunoadsorption (Ig‐Therasorb)

Abstract

Summary. Coagulation inhibitors may occur as alloantibodies in patients with congenital factor deficiencies or as autoantibodies in patients with a previously normal coagulation. We treated 10 patients with factor VIII inhibitors (three haemophiliacs and seven patients with acquired factor VIII inhibitors) and one patient with a factor V inhibitor using extracorporeal immunoadsorption to immobilized antibodies against human immunoglobulins (Ig-Therasorb). The initial inhibitor titre was between 18 BU/ml and 540 BU/ml. Nine patients had signs of bleeding. Eighty-nine immunoadsorption sessions were performed in the 11 patients (8´1^5´1 per patient), each processing 6980^880 ml of plasma in 3´8^0´5 h. The mean reduction of the inhibitor titre was 71´9^19´4% per session. Serum IgG, IgA and IgM levels decreased by 68´7^10´1%, 55´7^12´7% and 48´6^11´1% respectively. In two haemophiliac patients, an initial titre reduction prior to an immune tolerance protocol was performed. Another haemophiliac patient was treated because of acute cerebral bleeding. In six out of eight patients with acquired inhibitors, a durable elimination was achieved within a median of 18 d. Treatment was safe and well-tolerated and seems to be a promising method in the treatment of patients with coagulation inhibitors, especially when a fast inhibitor titre reduction is necessary.

Prolonged red cell aplasia after major ABO-incompatible allogeneic hematopoietic stem cell transplantation: removal of persisting isohemagglutinins with Ig-Therasorb® immunoadsorption

“…Treatment with B-cell-directed antibodies such as rituximab may be an approach, but only one report has been published so far. 11 Our attempt to remove isohemagglutinins with Ig-Therasorb s , a device that has been successfully used for the removal of circulating antibodies in a variety of hematologic and immunologic diseases, 12,13 was able to remove the antibodies effectively, to restore erythropoiesis and to render the patients transfusion independent. However, our observations suggest that a complete removal of the antibodies can only be achieved by treatment of large plasma volumes at daily intervals.…”

“…11 Removal of immunoglobulins with Ig-Therasorb s immunoadsorption is a novel method for the treatment of various hematologic and immunologic diseases, such as acquired coagulation factor inhibitors, dilated cardiomyopathy and the removal of anti-HLA antibodies prior to renal transplantation. 12,13 We report our experience with Ig-Therasorb s immunoadsorption for the treatment of five patients with PRCA due to persisting isohemagglutinins after major ABO-incompatible HSCT.…”

Acquired factor VIII inhibitors

“…65 The introduction of immunoadsorption techniques, including sepharose-bound staphylococcal protein A and sepharosebound polyclonal sheep antihuman antibodies, has increased the volume of plasma processed and the efficacy of the procedure. 66,67 The transitory drop of the inhibitor titer permits replacement therapy with human FVIII concentrates, which must then be administered immediately after the treatment cycle to achieve hemostasis. 68 Immunoadsorption has also been used in the setting of immune tolerance protocols (see "Immune tolerance").…”

Desenvolvimento de inibidores do fator VIII na hemofilia A

“…Alguns grupos têm relatado o tratamento de pacientes com altos títulos de inibidor (anti-fator V e anti-FVIII) utilizando métodos extracorpóreos de retirada de anticorpos. [52][53][54][55] Entretanto, as metodologias de retirada extracorpórea dos inibidores do FVIII não são específicas para estas imunoglobulinas e promovem a retirada de moléculas de anticorpo da circulação importantes para outras respostas imunes. Adicionalmente, em alguns casos, o indivíduo pode perder proteínas plasmáticas essenciais, como a albumina.…”