2002
DOI: 10.1046/j.1365-2516.2002.00626.x
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Inhibitors: resolving diagnostic and therapeutic dilemmas

Abstract: The good quality of life now anticipated by individuals with haemophilia A and B can be drastically altered by the unpredictable development of an inhibitor, a polyclonal high-affinity IgG antibody directed against factor VIII or IX. This paper discusses our current state of knowledge about inhibitors within the context of: (1) the extent and nature of the problem, including its incidence and prevalence, diagnostic options, and the characteristics of the individual immunologic response; (2) possible underlying… Show more

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Cited by 137 publications
(144 citation statements)
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“…1 The development of high-titer factor VIII inhibitors (>5 Bethesda units [BU]) complicates treatment because bleeding no longer responds to standard factor VIII replacement. 2,3 Alternative forms of clottingfactor concentrates, known as bypassing agents, are used to treat bleeding in these patients.…”
Section: Discussionmentioning
confidence: 99%
“…1 The development of high-titer factor VIII inhibitors (>5 Bethesda units [BU]) complicates treatment because bleeding no longer responds to standard factor VIII replacement. 2,3 Alternative forms of clottingfactor concentrates, known as bypassing agents, are used to treat bleeding in these patients.…”
Section: Discussionmentioning
confidence: 99%
“…In accord with our findings are observations in patients with hemophilia A and B in whom null alleles of factor VIII and IX, respectively, were associated with a high frequency of inhibitor development. 21,22 HLA class II subgroups were suggested to be a weak determinant for development of an inhibitor to factor VIII in hemophilia A. 23 All patients were exposed to plasma products.…”
Section: Discussionmentioning
confidence: 99%
“…Em resumo, as condições preeexistentes as quais parecem influenciar o desenvolvimento de anticorpos incluem: o tipo e a gravidade da hemofilia, a etnia do paciente, o genótipo da hemofilia e o imunofenótipo. 15 A predisposição genética para o desenvolvimento de inibidores anti-FVIII é demonstrada por estudos familiares. Nos regis-tros da MIBS (Malmö International Brother Study) foram encontrados mais membros de uma mesma família com inibidor do que poderia ser explicado por uma chance casual.…”
Section: Natureza Dos Anticorpos Inibidores Do Fviiiunclassified
“…Especificamente, é bastante debatido os riscos relativos do FVIII recombinante ou derivado do plasma para induzir a formação do anticorpo. 15 Recentemente, um estudo mostrou que o uso terapêutico de FVIII recombinante aumenta em cerca de 2,4 vezes o risco de desenvolver inibidores se comparado com o uso de FVIII derivado do plasma. 21 Outras situações ambientais devem modificar a predisposição genética para desenvolver o inibidor: o local de hemorragias frequentes; a coexistência de inflamação; a intensidade de reposição do fator; o estado nutricional.…”
Section: Natureza Dos Anticorpos Inibidores Do Fviiiunclassified
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