Effect of Treatment with Activated Prothrombin Complex Concentrate (FEIBA) on Factor VIII-Antibody Level

Summary

The influence of treatment with an activated prothrombin complex preparation (FEIBA) on the antibody level was studied in 10 haemophiliacs with an antibody to factor VIII. The antibody level was observed to rise at least once in five patients, while in the remaining five patients no rise occurred. In all, 6 out of 31 treatments were followed by an anamnestic rise of the antibody level, corresponding to 19.4%. A rise of the inhibitor level following FEIBA treatment is likely to occur in patients who show a marked antibody rise after factor VIII treatment (good responders), but have a low antibody level at the time of treatment. High doses of FEIBA and simultaneous transfusion of red cells may also enhance the likelihood of an anamnestic response. Stimulation of antibody production is probably due to the presence of small amounts of factor VIII in this preparation.

• References

• 1 Allain JP, Krieger GR. 1977. Use of prothrombin complex concentrate in the treatment of classical haemophilia with an inhibitor. Workshop on Inhibitors of Factors VIII and IX Facultas- Verlag; Vienna: 140
• 2 Abildgaard CF, Britton M, Harrison J. 1976; Prothrombin complex concentrate (Konyne) in the treatment of haemophilic patients with factor VIII inhibitors. Journal of Paediatrics 88: 200
• 3 Abildgaard CF, Britton M, Roberts R. 1974; Prothrombin complex concentrate (Konyne) for patients with factor VIII inhibitors. Blood 44: 933
• 4 Bloom AL. 1977. Discussion remark. Workshop on Inhibitors of Factors VIII and IX Facultas-Verlag; Vienna: 165
• 5 Goodnight Jr SH, Common HH, Lovrien EW. 1976; Factor VIII inhibitor following surgery for epidural haemorrhage in haemophilia: Successful therapy with a concentrate containing factors II, VII, IX and X. Journal of Paediatrics 2: 356
• 6 Kurczynski EM, Penner JA. 1974; Activated prothrombin concentrate for patients with factor VIII inhibitors. New England Journal of Medicine 291: 164
• 7 Lechner K. 1973; Immunoreactive factor VIII in carriers of haemophilia A⁺ and A^- . Thrombosis et Diathesis Haemorrhagica 29: 240
• 8 Lechner K, Niessner H, Nowotny CH R, Thaler E, Deutsch E. 1977. Differences in the immune response in haemophiliacs with acquired inhibition. Workshop on Inhibitors in Factors VIII and IX Facultas-Verlag; Vienna: 48
• 9 Lechner K. 1977. Collaborative study on factor VIII inhibitor assay. Workshop on Inhibitors of Factor VIII and IX Facultas-Verlag; Vienna: 32
• 10 Mannucci PM, Bader R, Ruggeri ZM. 1976; Concentrates of clotting factor IX. Lancet I 41
• 11 Mibashan RS. 1977. Discussion remark. Workshop on Inhibitors of Factors VIII and IX Facultas-Verlag; Vienna: 167
• 12 Nowotny CH, Lechner K, Niessner H, Thaler E. Clinical efficiency of an activated prothrombin complex preparation (FEIBA) in haemophiliacs with inhibitors. In preparation
• 13 Penner JA, Kelly PE. 1975; Management of patients with factor VIII or IX inhibitors. Seminars Thrombosis and Haemostasis. 1: 386
• 14 Rasche H, Bindewald H, Kohle W, Scheck R, Heinrich R, Seibert K. 1977; Notfallbehandlung von Blutungskomplikationen bei Hemmkörper-Hämophilie mit aktivierten Prothrombin-Komplex-Konzentraten. Deutsche Medizinische Wochenschrift 102: 319
• 15 Schimpf K, Zimmermann K. 1977. Response of a haemophiliac with an antibody to factor VIII and of a non-haemophiliac with a spontaneous factor VIII inhibitor to the administration of fraction FEIBA. Workshop on Inhibitors of Factors VIII and IX Facultas-Verlag; Vienna: 142
• 16 Shapiro SS, Hultin MA E. 1975; Acquired inhibitors to the blood coagulation factors. Seminars Thrombosis and Haemostasis 1: 336
• 17 Sonoda T, Solomon A, Krauss St, Cruz P, Jones FS, Levin J. 1976; Use of prothrombin complex concentrates in the treatment of a haemophilic patient with an inhibitor of factor VIII. Blood 47: 983
• 18 Sultan Y, Brouet JC, Debre P. 1974; Treatment of inhibitors to factor VIII with activated prothrombin concentrate. New England Journal of Medicine 291: 164
• 19 Tishkoff GH. 1977. Factor IX concentrate to treat factor VIII inhibitor: Biochemical studies on its mode action. Workshop on Inhibitors of Factors VIII and IX. Facultas-Verlag; Vienna: 103
• 20 Tishkoff GH. 1975; Prothrombin complex to treat factor VIII inhibitors. New England Journal of Medicine 292: 754
• 21 Vermylen J, Schetz J, Semeraro N, Verstraete M. 1977. Clinical and laboratory experience with fraction R: Attempts at identifiying the active principle. Workshop on Inhibitors of Factors VIII and IX. Facultas-Verlag; Vienna: 110