Immunoadsorption for removal of inhibitors: update on treatments in Malmö–Lund between 1980 and 1995

Abstract

Treatment of severe bleeding and the performance of surgery in Haemophilia patients with inhibitors creates severe problems. It is generally agreed that treatment is most effective if circulating levels of factor VIII/IX can be achieved long enough for control of heamostasis. Immunoadsorption with protein A for the removal of inhibitor has improved treatment for patients with initial inhibitor titres too high to neutralize by infusion alone. This is a summary of our experience in Malmö regarding immunoadsorption and heamostatis. A total of 19 applications with immunoadsorption in 10 patients were performed. On all occasions it was possible to eliminate totally the inhibitor or reduce it to low levels that could easily be neutralized with factor concentrate. Heamostatic levels of coagulation factors could be maintained for 5–9 days in all but one patient. This period was sufficient to stop ongoing heamorrhage or prevent excessive bleeding at surgical interventions.