Management of coagulation factor VIII (FVIII) inhibitors. 2019

Riitta Lassila
Helsinki University Hospital, Coagulation Disorders Unit, Hematology, Helsinki, Finland. Electronic address: riitta.lassila@hus.fi.

Acquired hemophilia is a rare but severe condition, which is unknown to medical specialties outside hematology. Sudden appearance of antibodies against coagulation FVIII is diagnosed by abnormal subcutaneous large and multiple hematomas with minor injuries only. APTT is prolonged, FVIII activity variably low and inhibitor titer varies, too. The antibodies are typically occurring in women after delivery and later in life at around 60 years of life due to immunological challenges, and in association with malignant diseases. Rapid recognition of the condition and support of hemostasis together with immunosuppressive therapy is important, since the diagnostic delay is a poor prognostic sign. Coagulation experts should be consulted to arrange the management and followup of the patients. Management of bleeds consists of so-called FVIII bypassing agents, activated prothrombin complex concentrate, aPCC, recombinant FVIIa or porcine FVIII. The immunotherapy should be continued for several weeks according to the timing of the remission. The relapse rate needs to be noted in the future under similar situations as the index event occurred. Register data collection is important to characterize this lifethreatening acquired bleeding disorder.

UI MeSH Term Description Entries
D008297 Male Males
D001779 Blood Coagulation Factors Endogenous substances, usually proteins, that are involved in the blood coagulation process. Clotting Factor,Coagulation Factors,Blood Coagulation Factor,Clotting Factors,Coagulation Factor,Coagulation Factor, Blood,Coagulation Factors, Blood,Factor, Coagulation,Factors, Coagulation,Factor, Blood Coagulation,Factor, Clotting,Factors, Blood Coagulation,Factors, Clotting
D005169 Factor VIII Factor VIII of blood coagulation. Antihemophilic factor that is part of the factor VIII/von Willebrand factor complex. Factor VIII is produced in the liver and acts in the intrinsic pathway of blood coagulation. It serves as a cofactor in factor X activation and this action is markedly enhanced by small amounts of thrombin. Coagulation Factor VIII,Factor VIII Clotting Antigen,Factor VIII Coagulant Antigen,Factor VIII Procoagulant Activity,Thromboplastinogen,Blood Coagulation Factor VIII,F VIII-C,Factor 8,Factor 8 C,Factor Eight,Factor VIIIC,Hyate-C,Hyatt-C,F VIII C,Hyate C,HyateC,Hyatt C,HyattC
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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