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Ghozlani I, Mounach A, Ghazi M, Kherrab A, Niamane R. Targeting Acquired Hemophilia A with Rheumatoid Arthritis by a Rituximab Shot: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:582-588. [PMID: 29780157 PMCID: PMC5993004 DOI: 10.12659/ajcr.908854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Patient: Male, 66 Final Diagnosis: Acquired hemophilia A Symptoms: Polyarticular flare Medication: — Clinical Procedure: — Specialty: Rheumatology
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Affiliation(s)
- Imad Ghozlani
- Department of Rheumatology, 1st Military Medical-Surgical Center, Agadir, Morocco.,Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco
| | - Aziza Mounach
- Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco.,Department of Rheumatology, Military Hospital Mohammed V, Rabat, Morocco
| | - Mirieme Ghazi
- Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco.,Department of Rheumatology, Military Hospital Avicenne, Marrakesh, Morocco
| | - Anass Kherrab
- Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco.,Department of Rheumatology, Military Hospital Avicenne, Marrakesh, Morocco
| | - Radouane Niamane
- Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco.,Department of Rheumatology, Military Hospital Avicenne, Marrakesh, Morocco
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52
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Wernham AG, Peng C, Bailiff B, Ilchyshyn A. Pemphigus foliaceus and acquired haemophilia: a rare but important association with life-threatening consequences. Clin Exp Dermatol 2018; 43:825-828. [PMID: 29777540 DOI: 10.1111/ced.13617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2018] [Indexed: 11/26/2022]
Affiliation(s)
- A G Wernham
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Foundation TrustCoventry, Clifford Bridge Road, CV2 2DX, UK
| | - C Peng
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Foundation TrustCoventry, Clifford Bridge Road, CV2 2DX, UK
| | - B Bailiff
- Department of Haematology, University Hospitals Coventry and Warwickshire NHS Foundation TrustCoventry, Clifford Bridge Road, CV2 2DX, UK
| | - A Ilchyshyn
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Foundation TrustCoventry, Clifford Bridge Road, CV2 2DX, UK
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53
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Andreadis P, Kafantari K, Agapidou A, Vakalopoulou S, Vlachaki E. Successful Outcome of Severe Intra-cerebral Bleeding Associated with Acquired Factor V Inhibition: Utilization of Multiple Therapeutic Agents. Balkan Med J 2018; 35:112-115. [PMID: 28903884 PMCID: PMC5820439 DOI: 10.4274/balkanmedj.2017.0158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Acquired coagulation factor inhibitors are antibodies that either inhibit activity or increase the clearance of a clotting factor and lead to an increased risk of bleeding. Most of the time, the disorder is attributed to factor VIII inhibition (acquired haemophilia A); however, other coagulation factors could also be implicated. Case Report: Herein, we report an interesting case of a patient who underwent coronary artery bypass grafting and received antibiotic treatment after surgery with third generation cephalosporin. A month later, he presented with extreme bleeding diathesis and cerebral haemorrhage. Following a thorough clinical and laboratory investigation, an acquired factor V inhibitor was diagnosed. The patient received treatment with corticosteroids, intravenous immunoglobulins, anti-CD20 monoclonal antibodies (rituximab), cyclophosphamide and recombinant factor VIIa. Finally, despite the poor initial prognosis, the patient managed to achieve a full recovery. Conclusion: As there are no clear guidelines on acquired coagulation inhibitor treatment, reports of such cases could offer insight for future therapy choices. The case was unique because the treatment regimen included a combination of multiple therapeutic agents including rituximab.
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Affiliation(s)
- Panagiotis Andreadis
- Clinic of Internal Medicine, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Katerina Kafantari
- Clinic of Internal Medicine, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Aleka Agapidou
- Clinic of Hematology, Homerton University Hospital, Homerton Row, London
| | - Sofia Vakalopoulou
- Clinic of Internal Medicine, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Efthymia Vlachaki
- Clinic of Internal Medicine, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece
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54
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Batty P, Moore G, Platton S, Maloney J, Palmer B, Bowles L, Pasi J, Rangarajan S, Hart D. Diagnostic accuracy study of a factor VIII ELISA for detection of factor VIII antibodies in congenital and acquired haemophilia A. Thromb Haemost 2017; 114:804-11. [DOI: 10.1160/th14-12-1062] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/19/2015] [Indexed: 11/05/2022]
Abstract
SummaryAntibody formation to factor VIII (FVIII) remains the greatest clinical and diagnostic challenge to the haemophilia-treating physician. Current guidance for testing for inhibitory FVIII antibodies (inhibitors) recommends the functional Nijmegen-Bethesda assay (NBA). A FVIII ELISA offers a complementary, immunological approach for FVIII antibody testing. It was the aim of this study to retrospectively evaluate the performance of a FVIII ELISA (index) for detection of FVIII antibodies, compared with the NBA (reference). All samples sent for routine FVIII antibody testing at two haemophilia Comprehensive Care Centres, were tested in parallel using the NBA and a solid-phase, indirect FVIII ELISA kit (Immucor). A total of 497 samples from 239 patients (severe haemophilia A=140, non-severe haemophilia A=85, acquired haemophilia A=14) were available for analysis. Sixty-THree samples tested positive by the NBA (prevalence 12.7 %, 95 % confidence interval [CI], 9.9–15.9 %), with a median inhibitor titre of 1.2 BU/ml (range 0.7–978.0). The FVIII ELISA demonstrated a specificity of 94.0 % (95 %CI, 91.3–96.0), sensitivity of 77.8 % (95 %CI, 65.5–87.3), negative predictive value of 96.7 % (95 %CI, 94.5–98.2), positive predictive value 65.3 % (95 %CI, 53.5–76.0), negative likelihood ratio 0.2 (95 %CI, 0.1–0.4), positive likelihood ratio 13.0 (95 %CI, 8.7–19.3) and a diagnostic odds ratio of 54.9 (95 %CI, 27.0–112.0). Strong positive correlation (r=0.77, p< 0.001) was seen between the results of the NBA (log adjusted) and FVIII ELISA optical density. In conclusion, FVIII ELISA offers a simple, specific, surveillance method enabling batch testing of non-urgent samples for the presence of FVIII antibodies.
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55
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Entrena Ureña L, Fernández Jiménez D, Gutiérrez Pimentel MJ. Tratamiento y complicaciones en la hemofilia A adquirida. Experiencia en un centro. Med Clin (Barc) 2017; 149:457-459. [DOI: 10.1016/j.medcli.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/07/2017] [Accepted: 08/09/2017] [Indexed: 11/16/2022]
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56
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Liu W, Xue F, Liu XF, Jiang EL, Yang DL, Liu KQ, Xiao ZJ, Zhang FK, Feng SZ, Han MZ, Zhang L, Yang RC. [Analysis of clinical efficacy of recombinant activated factor Ⅶ on bleeding in patients with hematologic disorders]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2017; 38:410-414. [PMID: 28565741 PMCID: PMC7354194 DOI: 10.3760/cma.j.issn.0253-2727.2017.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Indexed: 11/18/2022]
Abstract
Objective: To investigate the treatment efficacy of recombinant activated factor Ⅶ (rFⅦa) for bleeding among patients with hematologic disorders. Methods: A total of 38 times of bleeding in 31 patients with hematological disease treated with rFⅦa were analyzed retrospectively. Results: The clinical effective rate of rFⅦa for bleeding management in acquired hemophilia A (AHA) patients/hemophilia patients with inhibitor, acute promyelocytic leukemia (APL) patients and patients with non-APL leukemia was 90% (9/10) , 71.4% (5/7) and 60.0% (3/5) , respectively, which was higher than that in patients following HSCT (30.8%) . The clinical effective rate of rFⅦa for patients with bleeding score of 2 (100.0%) was higher than that with 3 (66.7%) and 4 (54.1%) . The effective rate of rFⅦa was 25.0% (2/5) in 5 patients with cerebral hemorrhage, 66.7% (6/9) in 9 patients with hematuria and 41.7% in 12 patients with gastrointestinal hemorrhage. The curative effect for 3 patients with joints and muscle bleeding and 5 patients with skin, nasal, pharyngeal and gum bleeding was excellent. Following HSCT, among patients with bleeding score of 4 points, high dose and repeated use of rFⅦa did not necessarily achieve a good effect. Among AHA/hemophilia patients with inhibitors and patients with acute leukemia who had bleeding score of 4 points, the use of low dose FⅦa could achieve good therapeutic effect, however the efficacy of lowest dose (22.5 μg/kg) rFⅦa was poor. Conclusions: The hemostasis efficacy of rFⅦa is affected by various factors such as diseases, bleeding sites, bleeding score and so on. The use of rFⅦa can achieve good efficacy for bleeding management in AHA patients/hemophilia patients with inhibitor, APL patients and patients with non-APL leukemia. However the efficacy of rFⅦa for bleeding of patients after HSCT is poor. Early use of rFⅦa is important for successful hemostatic treatment. Management of underlying condition is as important as hemostatic treatment.
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Affiliation(s)
- W Liu
- Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
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57
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Franchini M, Vaglio S, Marano G, Mengoli C, Gentili S, Pupella S, Liumbruno GM. Acquired hemophilia A: a review of recent data and new therapeutic options. ACTA ACUST UNITED AC 2017; 22:514-520. [PMID: 28441921 DOI: 10.1080/10245332.2017.1319115] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Acquired hemophilia A (AHA) is a rare, but potentially life-threatening, bleeding disorder caused by an autoantibody against factor VIII that interferes with its coagulant function. METHODS We performed a narrative review focusing on the diagnostic aspects of AHA and on the current treatment strategies with particular regard to new data and therapeutic developments. RESULTS The management of this severe hemorrhagic disorder is based on the control of bleeding with the use of bypassing agents and on the utilization of a variety of immunosuppressant agents with the goal of eliminating the autoantibody permanently. CONCLUSION The optimal management of AHA should be multidisciplinary and requires a close collaboration between physicians from various specialties.
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Affiliation(s)
- Massimo Franchini
- a Italian National Blood Centre, National Institute of Health , Rome , Italy.,b Department of Haematology and Transfusion Medicine , 'Carlo Poma' Hospital , Mantua , Italy
| | - Stefania Vaglio
- a Italian National Blood Centre, National Institute of Health , Rome , Italy.,c Department of Clinical and Molecular Medicine , 'Sapienza' University of Rome , Rome , Italy
| | - Giuseppe Marano
- a Italian National Blood Centre, National Institute of Health , Rome , Italy
| | - Carlo Mengoli
- a Italian National Blood Centre, National Institute of Health , Rome , Italy
| | - Sara Gentili
- a Italian National Blood Centre, National Institute of Health , Rome , Italy
| | - Simonetta Pupella
- a Italian National Blood Centre, National Institute of Health , Rome , Italy
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58
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Tavares Bello C, Vasylenko Y, Esteves J, Vasconcelos CA. Diabetes mellitus and acquired haemophilia: new association? BMJ Case Rep 2017; 2017:bcr-2017-219807. [PMID: 28438758 DOI: 10.1136/bcr-2017-219807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Diabetes mellitus encompasses a group of highly prevalent carbohydrate metabolic disorders with an increasing incidence. Some subtypes are thought to be associated with other immune-mediated diseases. Acquired haemophilia on the other hand is a quite rare autoimmune disease that is thought to be secondary to the emergence of inhibiting anticoagulation factor VIII antibodies (inhibitors) in patients with previously normal haemostatic function. More recently, numerous different diseases have been associated with acquired haemophilia namely immune-mediated diseases, drugs and solid and haematologic neoplasms. The authors report on a case of a patient with new onset acquired haemophilia arising in the setting of diabetic ketoacidosis.
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Affiliation(s)
- Carlos Tavares Bello
- Endocrinology, Centro Hospitalar de Lisboa Ocidental-Hospital de Egas Moniz, Lisboa, Portugal
| | - Yuliya Vasylenko
- Immunotherapy, Centro Hospitalar de Lisboa Ocidental - Hospital de Egas Moniz, Lisboa, Portugal
| | - José Esteves
- Immunotherapy, Centro Hospitalar de Lisboa Ocidental - Hospital de Egas Moniz, Lisboa, Portugal
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59
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Hemofilia adquirida: epidemiología, clínica, diagnóstico y tratamiento. Med Clin (Barc) 2017; 148:314-322. [DOI: 10.1016/j.medcli.2016.11.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/04/2016] [Accepted: 11/08/2016] [Indexed: 11/20/2022]
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60
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61
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Subramanian H, Kar R, Charles D, Babu H, Ambika P, Dutta TK. A Confounding Case of Inherited Factor V Deficiency Complicated by Inhibitors at First Presentation. Transfus Med Hemother 2016; 44:114-117. [PMID: 28503128 DOI: 10.1159/000450793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 09/10/2016] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Inherited factor V deficiency / Owren's disease has varied clinical manifestations ranging from asymptomatic laboratory abnormalities to massive hemorrhage. The acquired form due to inhibitors following antibiotic therapy, infection, or surgery is less common, and spontaneous development of inhibitors is not known. CASE REPORT An 18-year-old boy presented with bleeding axillary and groin ulcers. At the age of 15, due to recurrent epistaxis and gum bleed, he was diagnosed with acquired factor V deficiency with positive inhibitor screen and treated with fresh frozen plasma (FFP) transfusion and temporary azathioprine. Coagulation workup at his current presentation also revealed acquired factor V deficiency with presence of inhibitors. The tests were repeated after 6 weeks of intermittent FFP transfusion, and the differences observed included negative inhibitor screen and complete correction on mixing studies, but factor V level was 2%. DISCUSSION Evidence of inhibitors at presentation favored acquired disease. However, younger age of onset, detection of inhibitors 1 year after first episode of self-regressing bleed, lack of identifiable triggers, and persistent bleeding with reduced factor levels after disappearance of inhibitors favored inherited factor V deficiency. CONCLUSION In this case report, we have described an interesting case of severe inherited factor V deficiency with spontaneous appearance and disappearance of inhibitors exhibiting nonspecific factor inhibitory activity.
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Affiliation(s)
- Hema Subramanian
- Department of Pathology (Hematology Section), Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Rakhee Kar
- Department of Pathology (Hematology Section), Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Deepak Charles
- Department of Internal Medicine (Clinical Hematology Unit), Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Hitha Babu
- Department of Internal Medicine (Clinical Hematology Unit), Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Pagadalu Ambika
- Department of Pathology (Hematology Section), Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Tarun Kumar Dutta
- Department of Internal Medicine (Clinical Hematology Unit), Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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62
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Saito M, Kanaya M, Izumiyama K, Mori A, Irie T, Tanaka M, Morioka M, Ieko M. Treatment of bleeding in acquired hemophilia A with the proper administration of recombinant activated factor VII: single-center study of 7 cases. Int J Gen Med 2016; 9:393-399. [PMID: 27843336 PMCID: PMC5098745 DOI: 10.2147/ijgm.s118422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Recombinant activated factor VII (rFVIIa) is the bypassing agent used in the first-line hemostatic therapy for acquired hemophilia A (AHA); however, the occurrence of thrombotic complications in rFVIIa-treated AHA patients was recently reported to be 2.9–6.5%. Therefore, the investigation of the proper administration of rFVIIa for AHA is needed. In the present study, we retrospectively investigated the clinical features of AHA with regards to the use of rFVIIa (presence or absence of use and total amount) in 7 AHA patients encountered in our department for 7 years between January 2008 and December 2014. Ages were 63–89 years old (median: 79 years old), and there were 5 male and 2 female patients. The coexistence of cardiovascular risk factors and arteriosclerotic diseases, such as hypertension, diabetes mellitus, and cerebral infarction were present in 6 patients. Anemia progressed to less than 7 g/dL of hemoglobin and required red blood cell transfusion in 5 patients, showing “severe” hemorrhage. Factor VIII inhibitors were removed by immunological treatments in 6 patients. As a hemostatic therapy, rFVIIa was used in 4 patients. rFVIIa was not administered or was administered at a very low dose (20 mg) to 3 and 1 patient, respectively, and bleeding stopped as inhibitor titers decreased and disappeared in these patients. Inhibitors did not disappear in 1 patient and the control of hemostasis became poor and was accompanied by intestinal hemorrhage. Although a large amount of rFVIIa (265 mg in total) was administered, the patient bled to death. Therefore, bleeding may be stopped without the administration of rFVIIa in some AHA cases, while the dose of rFVIIa is not necessarily related to hemostatic effects in other cases. Since the main aim of AHA treatments is the removal of inhibitors, caution is needed to ensure that more than the necessary amount of rFVIIa is not administered.
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Affiliation(s)
- Makoto Saito
- Department of Internal Medicine and Hematology, Aiiku Hospital, Japan
| | - Minoru Kanaya
- Department of Internal Medicine and Hematology, Aiiku Hospital, Japan
| | - Koh Izumiyama
- Department of Internal Medicine and Hematology, Aiiku Hospital, Japan
| | - Akio Mori
- Department of Internal Medicine and Hematology, Aiiku Hospital, Japan
| | - Tatsuro Irie
- Department of Internal Medicine and Hematology, Aiiku Hospital, Japan
| | - Masanori Tanaka
- Department of Internal Medicine and Hematology, Aiiku Hospital, Japan
| | - Masanobu Morioka
- Department of Internal Medicine and Hematology, Aiiku Hospital, Japan
| | - Masahiro Ieko
- Department of Internal Medicine, Health Sciences University of Hokkaido, Japan
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63
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Cheng J, Iorio A, Marcucci M, Romanov V, Pullenayegum EM, Marshall JK, Thabane L. Bayesian approach to the assessment of the population-specific risk of inhibitors in hemophilia A patients: a case study. J Blood Med 2016; 7:239-253. [PMID: 27822129 PMCID: PMC5087814 DOI: 10.2147/jbm.s103087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Developing inhibitors is a rare event during the treatment of hemophilia A. The multifacets and uncertainty surrounding the development of inhibitors further complicate the process of estimating inhibitor rate from the limited data. Bayesian statistical modeling provides a useful tool in generating, enhancing, and exploring the evidence through incorporating all the available information. Methods We built our Bayesian analysis using three study cases to estimate the inhibitor rates of patients with hemophilia A in three different scenarios: Case 1, a single cohort of previously treated patients (PTPs) or previously untreated patients; Case 2, a meta-analysis of PTP cohorts; and Case 3, a previously unexplored patient population – patients with baseline low-titer inhibitor or history of inhibitor development. The data used in this study were extracted from three published ADVATE (antihemophilic factor [recombinant] is a product of Baxter for treating hemophilia A) post-authorization surveillance studies. Noninformative and informative priors were applied to Bayesian standard (Case 1) or random-effects (Case 2 and Case 3) logistic models. Bayesian probabilities of satisfying three meaningful thresholds of the risk of developing a clinical significant inhibitor (10/100, 5/100 [high rates], and 1/86 [the Food and Drug Administration mandated cutoff rate in PTPs]) were calculated. The effect of discounting prior information or scaling up the study data was evaluated. Results Results based on noninformative priors were similar to the classical approach. Using priors from PTPs lowered the point estimate and narrowed the 95% credible intervals (Case 1: from 1.3 [0.5, 2.7] to 0.8 [0.5, 1.1]; Case 2: from 1.9 [0.6, 6.0] to 0.8 [0.5, 1.1]; Case 3: 2.3 [0.5, 6.8] to 0.7 [0.5, 1.1]). All probabilities of satisfying a threshold of 1/86 were above 0.65. Increasing the number of patients by two and ten times substantially narrowed the credible intervals for the single cohort study (1.4 [0.7, 2.3] and 1.4 [1.1, 1.8], respectively). Increasing the number of studies by two and ten times for the multiple study scenarios (Case 2: 1.9 [0.6, 4.0] and 1.9 [1.5, 2.6]; Case 3: 2.4 [0.9, 5.0] and 2.6 [1.9, 3.5], respectively) had a similar effect. Conclusion Bayesian approach as a robust, transparent, and reproducible analytic method can be efficiently used to estimate the inhibitor rate of hemophilia A in complex clinical settings.
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Affiliation(s)
- Ji Cheng
- Biostatistics Unit, St Joseph's Healthcare Hamilton; Department of Clinical Epidemiology and Biostatistics
| | - Alfonso Iorio
- Department of Clinical Epidemiology and Biostatistics; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Maura Marcucci
- Geriatrics, Fondazione Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Vadim Romanov
- Baxter HealthCare, Global Medical Affairs, Westlake Village, CA, USA
| | - Eleanor M Pullenayegum
- Child Health Evaluation Sciences, Hospital for Sick Children; Dalla Lana School of Public Health, University of Toronto, Toronto
| | - John K Marshall
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Division of Gastroenterology, Hamilton Health Science, Hamilton, ON, Canada
| | - Lehana Thabane
- Biostatistics Unit, St Joseph's Healthcare Hamilton; Department of Clinical Epidemiology and Biostatistics
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Kessler CM, Knöbl P. Acquired haemophilia: an overview for clinical practice. Eur J Haematol 2016; 95 Suppl 81:36-44. [PMID: 26679396 DOI: 10.1111/ejh.12689] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 01/20/2023]
Abstract
Acquired haemophilia is a potentially life-threatening bleeding disorder caused by the development of autoantibodies against coagulation factors, most commonly against factor (F) VIII (acquired haemophilia A; AHA). In around half of patients, an underlying disorder is associated with AHA; the remaining cases are idiopathic. Typically, the disorder presents with bleeding, ranging from mild to life- and limb-threatening, in patients with no personal or family bleeding history. Diagnosis involves an isolated prolongation of the activated partial thromboplastin time, without correction in mixing studies, low FVIII activity levels and evidence of a FVIII inhibitor. As AHA is rare, a lack of familiarity of the condition may result in delayed diagnosis, and prompt haemostatic control is required to reduce morbidity and mortality. Bypassing agents (recombinant activated factor VII or activated prothrombin complex concentrates) can be used to control acute bleeding, and immunosuppression is necessary to eradicate the inhibitor. As clinical trials in this rare and heterogeneous disease are difficult, current evidence comes from observational studies, including registries. This review will focus on the diagnostic and therapeutic challenges of AHA and summarise how understanding of this complex condition has increased based on recent registry data.
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Affiliation(s)
- Craig M Kessler
- Division of Hematology-Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Paul Knöbl
- Division of Hematology and Hemostasis, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
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65
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Bambauer R, Latza R, Burgard D, Schiel R. Therapeutic Apheresis in Hematologic, Autoimmune and Dermatologic Diseases With Immunologic Origin. Ther Apher Dial 2016; 20:433-452. [PMID: 27633388 DOI: 10.1111/1744-9987.12474] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Indexed: 01/04/2023]
Abstract
The process of curing a patient by removing his illness by extracting blood is a very old one. Many years ago, phlebotomy was practiced to cure illness. Now, this old process, placed on a rational basis with therapeutic apheresis (TA), is being followed in clinical practice. Therapeutic plasma exchange (TPE) with hollow fiber modules has been used in different severe diseases for more than 40 years. Based on many years of experience with the extracorporeal circulation in end-stage renal disease, the authors herein give an overview of TA in immunological diseases, especially in hematologic, autoimmune and dermatologic diseases. Updated information on immunology and molecular biology of different immunological diseases is discussed in relation to the rationale for apheresis therapy and its place in combination with other modern therapies. With the introduction of novel and effective biologic agents, TA is indicated only in severe cases, such as in rapid progression despite immunosuppressive therapy and/or biologic agents. In mild forms of autoimmune disease, treatment with immunosuppressive therapies and/or biologic agents seems to be sufficient. The prognosis of autoimmune diseases with varying organ manifestations has improved in recent years, due in part to very aggressive therapy schemes. For the immunological diseases that can be treated with TA, the guidelines of the German Working Group of Clinical Nephrology and of the Apheresis Applications Committee of the American Society for Apheresis are cited. TA has been shown to effectively remove the autoantibodies from blood and lead to rapid clinical improvement.
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Affiliation(s)
- Rolf Bambauer
- Formerly: Institute for Blood Purification, 66424, Homburg, Germany.
| | | | | | - Ralf Schiel
- Inselklinik Heringsdorf GmbH, 17424, Seeheilbad Heringsdorf, Germany
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66
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Autoimmune acquired factor XIII deficiency due to anti-factor XIII/13 antibodies: A summary of 93 patients. Blood Rev 2016; 31:37-45. [PMID: 27542511 DOI: 10.1016/j.blre.2016.08.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/14/2016] [Accepted: 08/02/2016] [Indexed: 11/22/2022]
Abstract
Autoimmune acquired factor XIII (F13) deficiency or autoimmune hemophilia-like disease (hemorrhaphilia) resulted from the generation of anti-F13 antibodies (AH13) is a severe bleeding disorder that occurs mainly in the elderly. Although rare, the number of patients diagnosed with AH13 has recently increased. To improve understanding of this disease, the author summarized 93 ever reported/diagnosed AH13 cases. About 50% of cases were idiopathic. In the remaining half of the patients, autoimmune diseases and malignancies were the most common underlying diseases. Intramuscular and subcutaneous bleeding were the most frequently reported symptoms. Hemorrhage was the cause of death in 13 patients. In 4 patients, the diagnosis was established after hemorrhagic death. Therefore, physicians/hematologists must raise the awareness of AH13 as a life-threatening disease. Most patients were treated with F13 concentrates to arrest bleeding and with prednisolone and cyclophosphamide to eradicate anti-F13 autoantibodies. AH13 cases tend to become chronic and intractable and require close follow-up over an extended period.
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Tarantino MD, Cuker A, Hardesty B, Roberts JC, Sholzberg M. Recombinant porcine sequence factor VIII (rpFVIII) for acquired haemophilia A: practical clinical experience of its use in seven patients. Haemophilia 2016; 23:25-32. [DOI: 10.1111/hae.13040] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | - A. Cuker
- Penn Comprehensive Hemophilia and Thrombosis Program; Perelman School of Medicine; University of Pennsylvania; Philadelphia PA USA
| | - B. Hardesty
- Indiana Hemophilia and Thrombosis Center; Indianapolis IN USA
| | - J. C. Roberts
- Bleeding & Clotting Disorders Institute; Peoria IL USA
| | - M. Sholzberg
- Department of Medicine; Division of Hematology; Department of Laboratory Medicine and Pathobiology; St Michael's Hospital; University of Toronto; Toronto ON Canada
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Doma SA, Hillarp A, Pajič T, Andoljšek D, Černelč P, Preldžnik Zupan I. Concurrent acquired inhibitors to factor VIII and IX, a laboratory artifact: a case report. Biochem Med (Zagreb) 2016; 26:279-84. [PMID: 27346976 PMCID: PMC4910271 DOI: 10.11613/bm.2016.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/21/2016] [Indexed: 11/23/2022] Open
Abstract
Acquired inhibitors to coagulation factors other than factor VIII are extremely rare. We describe a case of a 59-year-old woman with abnormal bleeding, diagnosed with concurrent inhibitor antibodies to factor VIII and IX by Bethesda testing. We demonstrate that anti-FVIII antibodies of a very high titre are capable of disturbing the aPTT-based Bethesda assay, resulting in falsely-positive antibodies to factor IX. The case also illustrates the usefulness of the immunological assay (ELISA) in complementing the inhibitor diagnosis.
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Affiliation(s)
- Saša Anžej Doma
- Department of Hematology, University Medical Centre Ljubljana, Slovenia
| | - Andreas Hillarp
- Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden ; at the time of the investigation working at the Coagulation laboratory of Malmö Centre for Thrombosis and Haemostasis, Skane University Hospital, Malmö, Sweden
| | - Tadej Pajič
- Department of Hematology, University Medical Centre Ljubljana, Slovenia
| | - Dušan Andoljšek
- Department of Hematology, University Medical Centre Ljubljana, Slovenia
| | - Peter Černelč
- Department of Hematology, University Medical Centre Ljubljana, Slovenia
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Werwitzke S, Geisen U, Nowak-Göttl U, Eichler H, Stephan B, Scholz U, Holstein K, Klamroth R, Knöbl P, Huth-Kühne A, Bomke B, Tiede A. Diagnostic and prognostic value of factor VIII binding antibodies in acquired hemophilia A: data from the GTH-AH 01/2010 study. J Thromb Haemost 2016; 14:940-7. [PMID: 26988717 DOI: 10.1111/jth.13304] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Indexed: 11/26/2022]
Abstract
UNLABELLED Essentials Factor VIII (FVIII) binding IgG detected by ELISA could be an alternative to the Bethesda assay. We studied the performance of anti-FVIII IgG ELISA in patients with acquired hemophilia and controls. Anti-FVIII IgG > 99th percentile of controls was highly sensitive and specific. Patients with high anti-FVIII IgG have a lower chance of achieving remission. SUMMARY Background Acquired hemophilia A is a severe bleeding disorder that requires fast and accurate diagnosis as it occurs often unexpectedly in previously healthy men and women of every age. The Nijmegen-modified Bethesda assay is the diagnostic reference standard for detecting neutralizing autoantibodies against factor VIII (FVIII), but is not widely available, not ideal for quantifying the complex type 2 inhibitors seen in acquired hemophilia, and suffers from high inter-laboratory variability. Objectives To assess the diagnostic and prognostic value of FVIII-binding antibodies as detected by ELISA compared with the Nijmegen Bethesda assay. Methods Samples from the time of first diagnosis and clinical data were available from 102 patients with acquired hemophilia enrolled in the prospective GTH-AH 01/2010 study. Controls (n = 102) were matched for gender and age. Diagnostic cut-offs were determined by receiver-operator curve analysis. The prognostic value was assessed in 92 of the 102 patients by Cox regression analysis of time to partial remission. Results Anti-FVIII IgG above the 99th percentile (> 15 arbitrary units per mL) revealed high sensitivity and specificity (both 0.99; 95% confidence interval, 0.95-1.0) for diagnosing acquired hemophilia. The likelihood of achieving partial remission was related to anti-FVIII IgG concentration (< 300 arbitrary units, 1.0; 300-1050, 0.65; > 1050, 0.39). The Bethesda titer was only associated with the likelihood of partial remission when analyzed in the central laboratory, but not when data from local GTH study sites were used. Conclusion Although the Nijmegen-modified Bethesda assay is the reference standard for demonstrating neutralizing antibodies, the detection of FVIII-binding antibodies by ELISA is similarly sensitive and specific for diagnosing acquired hemophilia. In addition, anti-FVIII IgG may provide prognostic information.
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Affiliation(s)
- S Werwitzke
- Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - U Geisen
- Institute for Clinical Chemistry and Laboratory Medicine, Freiburg University Hospital, Freiburg, Germany
| | - U Nowak-Göttl
- Clinical Chemistry, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - H Eichler
- Clinical Hemostaseology and Transfusion Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - B Stephan
- Clinical Hemostaseology and Transfusion Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - U Scholz
- Center of Coagulation Disorders, Leipzig, Germany
| | - K Holstein
- Hematology and Oncology, University Hospital Eppendorf, Hamburg, Germany
| | - R Klamroth
- Internal Medicine, Vivantes Clinic Friedrichshain, Berlin, Germany
| | - P Knöbl
- Hematology and Hemostasis, Vienna Medical University, Vienna, Austria
| | - A Huth-Kühne
- Hemophilia Care Center, SRH Kurpfalzkrankenhaus Heidelberg, Heidelberg, Germany
| | - B Bomke
- Hemostasis, Hemotherapy, and Transfusion Medicine, Heinrich Heine University Center Medical Center, Düsseldorf, Germany
| | - A Tiede
- Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
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Pasquino P, Canaparo R, Capello T, Deorsola B, Perazzolo L, Marengo C, Serpe L. Acquired Hemophilia a may be Associated with Ticagrelor Therapy in a 52-Year-Old Man after a Recent Percutaneous Transluminal Coronary Angioplasty. CLINICAL MEDICINE INSIGHTS: CASE REPORTS 2016; 9:79-81. [PMID: 27660505 PMCID: PMC5022797 DOI: 10.4137/ccrep.s39788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/18/2016] [Accepted: 07/20/2016] [Indexed: 11/05/2022] Open
Abstract
We present a case report of a 52-year-old man who was hospitalized for right leg pain due to a relevant hemorrhagic effusion. He was on dual antiplatelet therapy (DAPT): acetylsalicylic acid and ticagrelor, a reversible P2Y12 receptor antagonist. Signs, symptoms, and laboratory blood tests led to the diagnosis of acquired hemophilia A (AHA). Ticagrelor therapy-associated AHA was hypothesized due to the fact that, before adding this drug, all laboratory and clinical examinations were repeatedly normal. Prednisone and cyclophosphamide treatment was started without DAPT interruption due to the high risk of stent thrombosis. After 10 days, prolonged activated partial thromboplastin time dropped from 107 to 49 seconds, the patient's factor VIII (FVIII) levels gradually normalized over the following few weeks, and FVIII inhibitor titer was negative. Recently, some reports have established a link between the development of AHA and treatment with clopidogrel, an irreversible P2Y12 receptor antagonist. However, to the best of our knowledge, this is the first time that a link between AHA and ticagrelor has been reported.
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Affiliation(s)
- Paola Pasquino
- Emergency Department, Unit of Internal Medicine, Santa Croce Hospital, Moncalieri, Italy
| | - Roberto Canaparo
- Department of Drug Science and Technology, University of Torino, Torino, Italy
| | - Tiziana Capello
- Emergency Department, Unit of Internal Medicine, Santa Croce Hospital, Moncalieri, Italy
| | - Barbara Deorsola
- Emergency Department, Unit of Internal Medicine, Santa Croce Hospital, Moncalieri, Italy
| | - Laura Perazzolo
- Emergency Department, Unit of Internal Medicine, Santa Croce Hospital, Moncalieri, Italy
| | - Claudio Marengo
- Emergency Department, Unit of Internal Medicine, Santa Croce Hospital, Moncalieri, Italy
| | - Loredana Serpe
- Department of Drug Science and Technology, University of Torino, Torino, Italy
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Lawless S, Benson G. A 75-year-old woman with acquired haemophilia disguised by warfarin treatment. BMJ Case Rep 2015; 2015:bcr-2015-211254. [PMID: 26443092 DOI: 10.1136/bcr-2015-211254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Acquired haemophilia is a rare coagulation disorder more commonly seen in elderly patients. Diagnosis and effective treatment can be delayed if patients are on warfarin treatment, as the bleeding symptoms may be erroneously attributed to this agent. We present a case report of a 75-year-old woman whose unexplained, severe and persistent bleeding was treated with surgical decompression and plasma transfusions, an appropriate management based on the assumption that warfarin was the cause of the bleeding. It was only when the patient's international normalised ratio returned to normal that a persistent abnormal activated partial thromboplastin time was noted. This delayed the correct diagnosis and treatment. Awareness of acquired haemophilia as a possible cause of sudden bleeding should be encouraged, and the wider dissemination of any relevant experience of similar cases would also be welcome.
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Affiliation(s)
| | - Gary Benson
- Haemophilia and Thrombosis Centre, Belfast City Hospital, Belfast, UK
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73
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Girardi DDM, Silva DRA, Villaça PR, Souza CE, da Fonseca LG, Bastos DA, Hoff PMG. Acquired hemophilia A in a patient with advanced prostate cancer. Autops Case Rep 2015; 5:55-9. [PMID: 26484336 PMCID: PMC4584669 DOI: 10.4322/acr.2015.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/15/2015] [Indexed: 11/23/2022]
Abstract
Acquired hemophilia A (AHA) is a rare disorder that results from the presence of autoantibodies against the clotting factor VIII (FVIII) causing hemorrhagic disorders. This entity is mostly associated with autoimmune diseases, pregnancy, the postpartum period, drugs and malignancy. Among the solid cancers, prostate neoplasm is the most common cause of AHA. The management of AHA involves the control of active bleeding and the use of specific therapies to eliminate the inhibitor. The authors describe the case of an 87-year-old man with prostate cancer who developed a bleeding disorder 5 years after the cancer diagnosis. Treatment with prednisone did not reach a satisfactory clinical response, which was only achieved with the association of azathioprine. The patient became asymptomatic with no further bleeding episodes, but developed a fatal sepsis after 3 months of treatment with these immunosuppressive agents.
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Affiliation(s)
- Daniel da Motta Girardi
- Clinical Oncology Department - Instituto do Câncer do Estado de São Paulo, São Paulo/SP - Brazil
| | | | - Paula Ribeiro Villaça
- Hospital das Clinicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Ciro Eduardo Souza
- Clinical Oncology Department - Instituto do Câncer do Estado de São Paulo, São Paulo/SP - Brazil
| | | | - Diogo Assed Bastos
- Clinical Oncology Department - Instituto do Câncer do Estado de São Paulo, São Paulo/SP - Brazil
| | - Paulo Marcelo Gehm Hoff
- Clinical Oncology Department - Instituto do Câncer do Estado de São Paulo, São Paulo/SP - Brazil
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74
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Acquired inhibitors of clotting factors: AICE recommendations for diagnosis and management. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 13:498-513. [PMID: 26192778 DOI: 10.2450/2015.0141-15] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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75
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Neufeld EJ, Négrier C, Arkhammar P, el Fegoun SB, Simonsen MD, Rosholm A, Seremetis S. Safety update on the use of recombinant activated factor VII in approved indications. Blood Rev 2015; 29 Suppl 1:S34-41. [PMID: 26073367 DOI: 10.1016/s0268-960x(15)30006-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Abstract
Acquired hemophilia A is a rare autoimmune disorder caused by an autoantibody (inhibitor) to factor VIII (FVIII) that interferes with its coagulant function and predisposes to severe, potentially life-threatening hemorrhage. Disease management focuses on controlling bleeding, primarily with the use of bypassing therapy and recombinant porcine FVIII, and permanently eradicating the autoantibody using various immunosuppressants. Treatment challenges include delayed diagnosis, difficulty achieving hemostasis and durable remissions, and complications associated with the use of hemostatic and immunosuppressive therapy in a primarily older patient population.
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Affiliation(s)
- Maissaa Janbain
- Louisiana Center for Bleeding and Clotting Disorders, Tulane University Medical Center, New Orleans, LA, USA
| | - Cindy A Leissinger
- Louisiana Center for Bleeding and Clotting Disorders, Tulane University Medical Center, New Orleans, LA, USA
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Zhang XH, Zhu XL, Niu T, Sun J, Liu H, Feng R, Yang LH, Wei Q, Ma QH, Wang QM, Feng FE, Fu HX, Mo XD, Lv M, Huang XJ. Combination of FVIII and low-dose rFVIIa improves haemostasis in acquired haemophilia A patients: a collaborative controlled study. Thromb Res 2015; 135:835-40. [PMID: 25747536 DOI: 10.1016/j.thromres.2015.02.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 02/11/2015] [Accepted: 02/17/2015] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Acquired haemophilia A (AHA) is an autoimmune disease that potentially leads to severe bleeding and has a high rate of mortality. This collaborative study aimed to assess the efficacy of the co-administration of FVIII and low-dose rFVIIa in patients with AHA. MATERIALS AND METHODS This study retrospectively compared the combined FVIII/low-dose rFVIIa therapy (initial dose range of 25-55μg/Kg) with the combined FVIII/PCC therapy and low-dose rFVIIa monotherapy. Adverse drug reactions and recurrent bleeding episodes were also monitored. Crude comparisons and the exact conditional logistic regression were performed to compare the outcomes between three treatment groups. RESULTS First bleeding episodes of 56 consecutive patients from 5 centres were analyzed, and 37 bleeding episodes (66.1%) were determined to be severe. Specifically, the rate of bleeding control was significantly higher with the FVIII/low-dose rFVIIa therapy compared to that of the low-dose rFVIIa alone therapy or the FVIII/PCC therapy (58.3% vs. 41.7% vs. 95.0%, respectively). Analyzing of total 236 bleeding episodes showed a clear positive association between the early initiation of haemostatic treatment and efficacy. No therapy-related adverse events in which thrombosis predominated were reported. CONCLUSIONS The combination of FVIII and low-dose rFVIIa offers an ideal haemostatic cover and may be promoted as a feasible and safe therapy protocol for patients with AHA.
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Affiliation(s)
- Xiao-Hui Zhang
- Peking University People's Hospital, Peking University Institute of Haematology, Beijing, P.R.C..
| | - Xiao-Lu Zhu
- Peking University People's Hospital, Peking University Institute of Haematology, Beijing, P.R.C
| | - Ting Niu
- Department of haematology, West China Hospital, West China School of Clinical Medicine, Sichuan University, Chengdu, Sichuan, P.R.C
| | - Jing Sun
- Department of haematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P.R.C
| | - Hui Liu
- Department of haematology, Beijing Hospital, Beijing, P.R.C
| | - Ru Feng
- Department of haematology, Beijing Hospital, Beijing, P.R.C
| | - Lin-Hua Yang
- Department of haematology, the Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, P.R.C
| | - Qing Wei
- Department of haematology, West China Hospital, West China School of Clinical Medicine, Sichuan University, Chengdu, Sichuan, P.R.C
| | - Qing-Hui Ma
- Department of haematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P.R.C
| | - Qing-Ming Wang
- Peking University People's Hospital, Peking University Institute of Haematology, Beijing, P.R.C
| | - Fei-Er Feng
- Peking University People's Hospital, Peking University Institute of Haematology, Beijing, P.R.C
| | - Hai-Xia Fu
- Peking University People's Hospital, Peking University Institute of Haematology, Beijing, P.R.C
| | - Xiao-Dong Mo
- Peking University People's Hospital, Peking University Institute of Haematology, Beijing, P.R.C
| | - Meng Lv
- Peking University People's Hospital, Peking University Institute of Haematology, Beijing, P.R.C
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Haematology, Beijing, P.R.C..
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Franchini M. Next-generation treatment of acquired hemophilia A. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1017470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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79
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Freeman A. Acquired haemophilia A presenting at a District General Hospital. CASE REPORTS 2015; 2015:bcr-2014-208001. [DOI: 10.1136/bcr-2014-208001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Kruse‐Jarres R, St‐Louis J, Greist A, Shapiro A, Smith H, Chowdary P, Drebes A, Gomperts E, Bourgeois C, Mo M, Novack A, Farin H, Ewenstein B. Efficacy and safety ofOBI‐1, an antihaemophilic factorVIII(recombinant), porcine sequence, in subjects with acquired haemophilia A. Haemophilia 2015; 21:162-170. [DOI: 10.1111/hae.12627] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2015] [Indexed: 11/28/2022]
Affiliation(s)
- R. Kruse‐Jarres
- Section of Hematology/Oncology Tulane University New Orleans LA USA
| | - J. St‐Louis
- Division of Hematology Hôpital Maisonneuve‐Rosemont University of Montreal Montreal QC Canada
| | - A. Greist
- Indiana Hemophilia and Thrombosis Center Indianapolis IN USA
| | - A. Shapiro
- Indiana Hemophilia and Thrombosis Center Indianapolis IN USA
| | - H. Smith
- Division of Hematology/Oncology Tufts New England Medical Center Boston MA USA
| | - P. Chowdary
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit Royal Free Hospital London UK
| | - A. Drebes
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit Royal Free Hospital London UK
| | - E. Gomperts
- Division of Hematology/Oncology Children's Hospital of Los Angeles Los Angeles CA USA
| | | | - M. Mo
- Baxter Healthcare Westlake Village CA USA
| | - A. Novack
- Baxter Healthcare Westlake Village CA USA
| | - H. Farin
- Baxter Healthcare Westlake Village CA USA
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Prognostic factors for remission of and survival in acquired hemophilia A (AHA): results from the GTH-AH 01/2010 study. Blood 2014; 125:1091-7. [PMID: 25525118 DOI: 10.1182/blood-2014-07-587089] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Acquired hemophilia A (AHA) is caused by autoantibodies against factor VIII (FVIII). Immunosuppressive treatment (IST) results in remission of disease in 60% to 80% of patients over a period of days to months. IST is associated with frequent adverse events, including infections as a leading cause of death. Predictors of time to remission could help guide IST intensity but have not been established. We analyzed prognostic factors in 102 prospectively enrolled patients treated with a uniform IST protocol. Partial remission (PR; defined as no active bleeding, FVIII restored >50 IU/dL, hemostatic treatment stopped >24 hours) was achieved by 83% of patients after a median of 31 days (range 7-362). Patients with baseline FVIII <1 IU/dL achieved PR less often and later (77%, 43 days) than patients with ≥1 IU/dL (89%, 24 days). After adjustment for other baseline characteristics, low FVIII remained associated with a lower rate of PR (hazard ratio 0.52, 95% confidence interval 0.33-0.81, P < .01). In contrast, PR achieved on steroids alone within ≤21 days was more common in patients with FVIII ≥1 IU/dL and inhibitor concentration <20 BU/mL (odds ratio 11.2, P < .0001). Low FVIII was also associated with a lower rate of complete remission and decreased survival. In conclusion, presenting FVIII and inhibitor concentration are potentially useful to tailor IST in AHA.
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Interference from lupus anticoagulant on von Willebrand factor measurement in splenic marginal zone lymphoma: a case report. Blood Coagul Fibrinolysis 2014; 26:454-7. [PMID: 25485787 DOI: 10.1097/mbc.0000000000000240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We present a case concerning a patient with splenic marginal zone lymphoma (SMZL) and isolated prolonged activated partial thromboplastin time (aPTT) caused by lupus anticoagulant. Von Willebrand factor (VWF) activity and antigen were immeasurable by latex particle immunoturbidimetric assays, and several coagulation factor levels were decreased. However, VWF activity and antigen were normal when analyzed by other methods. Also, coagulation factor levels were normal if an aPTT reagent with low lupus anticoagulant sensitivity or a chromogenic method was applied. Altogether, the initial findings were because of lupus anticoagulant interference and in fact, the patient had normal VWF activity and coagulation status. Interference of lupus anticoagulant in clot-based assays is well known but has not previously been described in VWF assays. This is furthermore the first report in which lupus anticoagulant activity in SMZL cannot be ascribed to a monoclonal immunoglobulin. In our study, aPTT normalized after treatment, suggesting resolution of lupus anticoagulant. APTT could thus be a marker of treatment response in SMZL. Whether treatment decreases the thrombosis risk due to lupus anticoagulant remains unknown.
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83
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Batty P, Palmer B, Chalmers E, Hay CRM, Liesner R, Rangarajan S, Talks K, Williams M, Collins P, Hart DP. A national survey of immunosuppression strategies for acquired haemophilia A. Haemophilia 2014; 21:e73-6. [PMID: 25422109 DOI: 10.1111/hae.12547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 11/30/2022]
Affiliation(s)
- P Batty
- The Royal London Hospital Haemophilia Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London, UK
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Acquired Factor XI Inhibitor Presenting as Spontaneous Bilateral Subdural Hematoma in an Elderly Patient. Case Rep Hematol 2014; 2014:626831. [PMID: 25431698 PMCID: PMC4241306 DOI: 10.1155/2014/626831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 10/16/2014] [Indexed: 11/29/2022] Open
Abstract
Development of autoantibodies against coagulation factors is an uncommon bleeding disorder associated with cancer, autoimmune conditions, pregnancy, or no apparent disease. Spontaneous FVIII inhibitors are the most frequently encountered; those against FXI have been only anecdotally reported. We report a case of acquired FXI inhibitor presenting as fatal intracranial spontaneous bleeding in an elderly patient with history of cancer and previous transfusions. Few cases of acquired FXI inhibitor have been reported in association with connective tissue disease, cancer, or surgery. Bleeding includes mucocutaneous bleeding, postsurgical hemorrhage, or life-threatening events. Treatment consists of arresting the bleeding and inhibitor eradication. High degree of suspicion is essential to promptly diagnose and treat this uncommon condition.
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85
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Faranoush M, Abolghasemi H, Mahboudi F, Toogeh G, Karimi M, Eshghi P, Managhchi M, Hoorfar H, Dehdezi BK, Mehrvar A, khoeiny B, Vaziri B, Kamyar K, Heshmat R, Baghaeipour MR, Mirbehbahani NB, Fayazfar R, Ahmadinejad M, Naderi M. A Comparison of Efficacy Between Recombinant Activated Factor VII (Aryoseven) and Novoseven in Patients With Hereditary FVIII Deficiency With Inhibitor. Clin Appl Thromb Hemost 2014; 22:184-90. [DOI: 10.1177/1076029614555902] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction: This study compared the efficacy of Aryoseven with Novoseven to control bleeding episodes in patients with hemophilia A with inhibitors. Methods: Sixty-six patients were randomized into 2 groups, with 4 consecutive block randomization. These groups received Aryoseven and Novoseven dosages of 90 to 120 μg/kg intravenously every 2 hours. Results: Median (interquartile range) level of factor VIII (FVIII) inhibitor in groups A and B was 15.0 and 19.0 Bethesda Unit (BU) preadministration. Bleeding onset in group A was 1246 ± 1104 minutes and in group B was 2301 ± 1693 minutes ( P = .311). The Kavakli global response scores and treatment success rate was comparable in both the groups. The side effects in groups A (9.7%) and B (2.9%) were comparable. Conclusion: Biosimilar recombinant activated FVII is found to be as effective as Novoseven in the treatment of acute joint bleeding in patients with hemophilia with inhibitors. Its usage will decrease the gaps in hemophilia.
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Affiliation(s)
- M. Faranoush
- Iran university of Medical Sciences, Rasool Akram Hospital, Tehran, Iran
| | - H. Abolghasemi
- Pediatric Congenital Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - F. Mahboudi
- Biotechnology Research Center, Pasteur Institute of Iran, Tehran Iran
| | - Gh. Toogeh
- Thrombosis and Hemostasis Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Iran
| | - M. Karimi
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - P. Eshghi
- Pediatric Congenital Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M. Managhchi
- Thrombosis and Hemostasis Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Iran
| | - H. Hoorfar
- Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | | | - B. Vaziri
- Biotechnology Research Center, Pasteur Institute of Iran, Tehran Iran
| | - K. Kamyar
- Aryogen Zist Darou Company, Karaj, Iran
| | - R. Heshmat
- Thrombosis and Hemostasis Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Iran
| | | | | | - R. Fayazfar
- MD, Kerman University of Medical Sciences, Kerman, Iran
| | - M. Ahmadinejad
- High Institute of Research, Iranian Blood Transfusion Organization, Tehran, Iran
| | - M. Naderi
- Zahedan University of Medical Sciences, Ahwaz, Iran
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