Submitted June 24, 2008
Accepted September 9, 2008
How we treat a hemophilia A patient with a factor VIII inhibitor
Christine L Kempton* and Gilbert C. White II
Aflac Cancer Center and Blood Disorders Service and Winship Cancer Institute, Emory University, Atlanta, GA, United States
Blood Research Institute, The Blood Center of Wisconsin, Milwaukee, WI, United States
* Corresponding author; email: ckempto{at}emory.edu.
The most significant complication of treatment in patients with hemophilia A is the development of alloantibodies that inhibit factor VIII activity. In the presence of inhibitory antibodies, replacement of the missing clotting factor by infusion of factor VIII becomes less effective. Once replacement therapy is ineffective, acute management of bleeding requires agents that bypass factor VIII activity. Long term management consists of eradicating the inhibitor through immune tolerance. Despite success in the treatment of acute bleeding and inhibitor eradication, there remains an inability to predict or prevent inhibitor formation. Ideally, prediction and ultimately prevention will come with an improved understanding of how patient-specific and treatment-related factors work together to influence anti-factor VIII antibody production.
