Circulating Anticoagulant after Pregnancy and its Response to ACTH

Nilsson, Inga Marie; Skanse, Bengt; Gydell, Karl

doi:10.1159/000205412

Cited by 28 publications

(8 citation statements)

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“…Treatment with prednisone (Table 2, cases 11, 12, 15, 18, 19, 25, 26) and/or with ACTH (Table 2, cases 10, 11, 12, 18) was usually found to be ineffective with the exception of 2 cases; the one described by Nilsson et al (1958), in which ACTH was reported to be effective after unsuccessful cortisone treatment, the other described by Robboy et al ( Table 2, case 24), in which systemic lupus erythematosus has been documented and prednisone seemed clinically effective. Chemotherapeutic immunosuppression has been applied in 3 cases.…”

Section: Discussionmentioning

confidence: 99%

Factor VIII Inhibitor Postpartum

Michiels

Bosch

Plas

et al. 1978

Scandinavian Journal of Haematology

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Acquired factor VIII deficiency in women postpartum due to a factor VIII inhibitor is rare and the etiology is unknown. In this study a case report and a review of the literature are given. The haemorrhagic diathesis resembles classic haemophilia, with the exception that ecchymoses and tissue bleeding occur more frequently. The potency of the inhibitor may vary from weak to strong and the inactivation of factor VIII coagulant activity (factor VIII‐C) by the inhibitor is of a non‐linear type. Severe bleeding has been fatal in a few cases, but factor VIII concentrate substitution has usually been successful without anamnestic response of inhibitor activity. There is no convincing evidence that immunosuppression is effective, also because the natural history of the disease is characterised by a spontaneous disappearance of the factor VIII‐C inhibitor. Treatment of bleeding symptoms with factor VIII concentrate should therefore not be reserved for life threatening haemorrhages only.

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Section: Discussionmentioning

confidence: 99%

Factor VIII Inhibitor Postpartum

Michiels

Bosch

Plas

et al. 1978

Scandinavian Journal of Haematology

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“…These observations taken together do not suggest that the anticoagulant is an antibody. Moreover although the idea that AHG is an antigenic substance for haemophilic patients is plausible it is dificult to see why if AHG became antigenic for a normal person the inhibitor should disappear as occurred in Case 2 and some other published cases (Singer, Mond, Hyman and Levy, 1950) Frick, 1953 ; O'Brien, 1954; Nilsson, Skanse and Gydell, 1958).…”

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confidence: 99%

A Method for the Study of Antihaemophilic Globulin Inhibitors with Reference to Six Cases

1959

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CIRCULATING anticoagulants arising in haemophilic patients or appearing sporadically in normal people have been studied by Hougie ( I~s s~) , Hougie and Fearnley (1954) and Bergsagel and Hougie (1956). The fmdmgs of these workers suggested that the h b i t o r prevented the reaction between antihaemophilic glob& and Christmas factor but that it was inactive towards the product of the reaction between these two substances. The admission to the Radcliffe Infirmary of five patients who had circulating anticoagulants stimulated a further study of this subject. The two problems of interest to us were the definition of the mode of action of the inhibitors and the development of a practical method for their detection and assay. We started our study from the hypothesis that the inlubitor might be a specific antagonist of antihaemophilic globulin and that more reliable measurements might be obtained by concentrating attention on the amount of this substance destroyed by the inhibitor. METHODS ASSAY OF ANTIHAEMOPHILIC GLOBULIN (AHG)The method used was method (e) of Biggs and Macfarlane (1957, p. 423). In this technique dilutions of the sample containing AHG are mixed with Factor V, phospholipid, serum and calcium chloride. At two time-intervals samples are transferred to normal recalcified plasma and the clotting times recorded as in the thromboplastin-generation test. Since our experiments often required 20-30 assays of AHG in a day the method was simplified by using two dilutions containing AHG instead of the four in the original test. The exact method of using this assay to measure an inhibitor is described in method B. DEMONSTRATION OF AHG INHIBITOR: METHOD AThe method using the thromboplastin-generation test described by Biggs and Macfarlane (1957) was used. In this test normal reagents for the thromboplastin-generation test are mixed and just before recalcification a measured volume of inhibitor-containing Al(OH), treated plasma is added. The highest dilution which will suppress thromboplastin formation is taken as a rough guide to the potency of the anticoagulant. ASSAY OF AHG INHIBITOR: METHOD BThe theoretical justification of this method is contained in the main part of the paper. In principle it consists of adding a known amount of animal AHG (the exact amount is not critical) to dilutions of inhibitor. The mixture is incubated at 37' C. for I hour and the amount of residual AHG in the mixture is assayed. * Postal address: Churchill Hospital, Oxford. 3 79 3 80 ReagentsInhibitor. This consists of Al(OH)3-treated plasma of a patient whose blood contains an inhibitor. The absorbed plasma is diluted as required with citrate s a h e (I part of 3.8 per cent sodium citrate and 5 parts of 0.85 per cent NaC1). The exact dilutions for any particular test depend on the potency of the inhibitor and have varied in our samples from I in I to I in 1024. The best dilution of dubitor to use is one which gives approximately 75 per cent destruction of added AHG in I hour.AHG. Animal AHG (bovine or porcine) is made up at a concentra...

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“…The treatment of patients with anticoagulants has created many problems. Steroids have been used with poor results (14, 21) except in occasional cases (28). One of the patients described by Feinstein et al (11) was treated with ACTH with good effect.…”

Section: Discussionmentioning

confidence: 99%

A Circulating Anticoagulant Against Factor V

Nilsson

Hedner

Ekberg

et al. 1974

Journal of Internal Medicine

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A 65-year-old man who developed a potent circulating anticoagulant directed against factor V is described. After prostatectomy he went into a septic shock and received treatment with cephalothin. After 12 days' treatment he developed severe bleedings and signs of drug allergy. Coagulation studies showed a factor V level of 0% and a circulating anticoagulant against factor V in high titre. The anticoagulant belonged to the IgG class. After treatment with cyclophosphamide in large doses and withdrawal of cephalothin the bleedings stopped and the anticoagulant successively decreased, and after 5 weeks he had a normal factor V level. In this case the anticoagulant probably developed as a consequence of the cephalothin therapy.

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Circulating Anticoagulant after Pregnancy and its Response to ACTH

Cited by 28 publications

References 0 publications

Factor VIII Inhibitor Postpartum

Factor VIII Inhibitor Postpartum

A Method for the Study of Antihaemophilic Globulin Inhibitors with Reference to Six Cases

A Circulating Anticoagulant Against Factor V

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