Treatment of Joint-Bleedings in Hemophiliacs with Antibodies to Factor VIII with High doses of Fraction Feiba.

Abstract

Observations in 3 patients demonstrated, that joint-bleedings can be controlled with high doses of fraction FEIBA alone or in combination with factor (f) VIII on out-patient basis. First patient, inhibitor 5-10 units (u) per ml, suffered from 24 joint-bleedings within 392 days. 2o of them could be stopped by a single injection of 150-200 u of fraction FEIBA per kg bodyweight (bw). A combination of 90 u of FEIBA and 36 u of f VIII per kg bw had the same effect. But after 5 injections of this combination within 6 weeks, the inhibitor level had risen from 10 to 240 u per ml. During further treatment with 180 u of fraction FEIBA without addition of f VIII, the inhibitor fell down with a half life time of 50 days. The clinical effect of fraction FEIBA was not influenced by the elevated antibody level. Two further patients, inhibitors 2-4 and 32 u respectively, obtained combined injections of 50-100 u of FEIBA plus 36-42 u of f VIII. One patient was on a prophylaxis of 3 injections weekly for 193 days. After 57 injections the inhibitor had fallen from 2-4 u to unmeasurable values. The third patient obtained the above mentioned dosis twice a day for treatment of a knee joint effusion. After 1 week the inhibitor was diminished from 32 to 13 u.

Failure of factor VIII inhibitor bypassing activity (Feiba) to secure haemostasis in haemophilic patients with antibodies.

“…The clinical details are summarised in Table 1. On six occasions therapy with Feiba was combined with factor VIII concentrate, as recommended by Schimpf et al (1977), at a dosage of 32-114 units/kg. In six of the 14 episodes, including two with external blood (15) loss, the bleeding progressed in spite of therapy with The whole blood clotting time (WBCT), pro-Feiba, and additional treatment was necessary.…”

“…In the present study, using the activated factor IX concentrate Feiba (Immuno), we have been impressed by the apparent lack of success of this form of treatment not only in closed bleeds, which are difficult to assess, but also in two patients with external bleeding even when used in high dosage and in combination with factor VIII concentrate (Schimpf et al, 1977;. The reasons for the conflicting results are difficult to determine.…”

“…Anamnestic response of factor VIII antibody is less likely to occur than with factor VIII concentrate, and the treatment is certainly much less expensive. Recently, Brackmann et al (1977) and Schimpf et al (1977) have claimed that a combination of high doses of factor VIII and factor IX concentrates may be effective and that sustained use may even lead to the disappearance of the factor VIII antibodies, but this claim has yet to be substantiated. The high cost, for example £1000 a day for many months in one patient (Brackmann and Gormsen, 1977), and the redistribution of blood products involved are undesirable aspects of this treatment programme.…”