Management of bleeding episodes with factor VIII concentrates in hemophiliacs with low titre inhibitor

Four patients with severe hemophilia A which had been found to have low titre inhibitor were treated on five occasions with factor VIII concentrates.Two patients with episodes of traumatic hemorrhage on the chin and intra-abdominal hematoma were treated immediately with factor VIII concentrates. On admission the inhibitor titres were almost undetectable. Factor VIII procoagulant activity (F. VIII: C) was expectedly raised to 160 and 46% respectively after infusion, and satisfactory hemostatic effects were observed in spite of anamnestic responce which began on the following 5-6th day.Two patients with three episodes such as labial hematoma, hematuria and intestinal bleeding were at first treated with factor IX concentrates, but there were no clinical improvement. At the time of treatment the inhibitor titre was 1.2, 0.86 and 0.1U/ml (Oxford unit), respectively. Therefore, each case was infused with factor VIII concentrate enough to neutralize inhibitor and gain satisfactory level of F. VIII: C for hemostasis.F. VIII: C was initially raised to 180, 92 and 72%, though the levels of 326, 274 and 86% were respectively expected. These results permitted the calculation that about 2U of factor VIII concentrates might be neutralized 1U of inhibitor.Good hemostatic effects were observed except one case with labial hematoma, which was controlled successfully with continuous infusion of factor IX concentrates.It was found advisable that factor VIII concentrates should be given firstly to control the life-threatening hemorrhage of the patients with low titre inhibitor, but it was difficult to treat the hemorrhage from mobile soft tissue with use of factor VIII concentrate alone.

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