Immunoadsorption with single‐use columns for the management of bleeding in acquired hemophilia A: A series of nine cases

Abstract

The presented cases support our assumption that patients with acquired hemophilia A benefit from IA with disposable columns in a setting of acute bleeding. This modality of IA is able to eliminate inhibitors reliably and quickly. IA in general is substantially speeding up the progress of therapy preventing bleeding complications constantly threatening the patient and reducing the dosages of coagulation factor therapy. We encourage IA with disposable columns in all bleeding patients with acquired hemophilia to aggressively lower the inhibitors.

Refractory Acquired Hemophilia: Successful Treatment by Immunoadsorption With Single‐Use Columns

“…The present case confirms the findings of Brzoska et al. (4) that disposable columns can be used successfully instead of reusable columns. Moreover, it shows that IA can be an efficient therapeutic measure in acquired hemophilia refractory to recombinant activated factor VII substitution and immunosuppressive treatment.…”

How I manage patients with acquired haemophilia A

“…Patients with severe, high titre AHA refractory to conventional bypass interventions may benefit from other alternative strategies for bleeding control. Numerous case reports describe the successful use of immunoadsorption (Guillet et al , ; Freedman et al , ; Brzoska et al , ; Seibert et al , ), proposing that rapid elimination of acquired inhibitors may be an effective means of achieving control of acute bleeding. Zeitler et al () built upon this concept and proposed that use of the modified Bonn Malmo protocol (MBMP) can achieve successful control of acute bleeding and maintain long‐term inhibitor eradication in AHA patients (Zeitler et al , ).…”

Current management of acquired factor VIII inhibitors

“…In addition, this intervention may be difficult to perform in small patients and those who are acutely bleeding [14 ]. Standard plasmapheresis, although more widely available than immunoadsorption, is unlikely to be effective and is associated with more side effects [28].…”